Provider Demographics
NPI:1376089359
Name:MOREHOUSE GENERAL HOSPITAL
Entity Type:Organization
Organization Name:MOREHOUSE GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-283-3601
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71221-1060
Mailing Address - Country:US
Mailing Address - Phone:318-283-3601
Mailing Address - Fax:
Practice Address - Street 1:323 W WALNUT AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4521
Practice Address - Country:US
Practice Address - Phone:318-283-3601
Practice Address - Fax:318-239-8601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOREHOUSE GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA167273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1705781Medicaid
LA108356105Medicaid
LA190C4201ZOtherBLUE CROSS PROFESSIONAL
LA60796OtherBLUE CROSS OF LA
LA1720135Medicaid
LA86259OtherBLUE CROSS OF AR
LA1797138Medicaid
LA190C4201ZOtherBLUE CROSS PROFESSIONAL