Provider Demographics
NPI:1467456814
Name:CALCASIEU CAMERON HOSPITAL SERVICE DISTRICT
Entity Type:Organization
Organization Name:CALCASIEU CAMERON HOSPITAL SERVICE DISTRICT
Other - Org Name:HACKBERRY RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRUGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-527-4241
Mailing Address - Street 1:1020 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HACKBERRY
Mailing Address - State:LA
Mailing Address - Zip Code:70645-3303
Mailing Address - Country:US
Mailing Address - Phone:337-762-3762
Mailing Address - Fax:337-762-3838
Practice Address - Street 1:1020 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKBERRY
Practice Address - State:LA
Practice Address - Zip Code:70645-3303
Practice Address - Country:US
Practice Address - Phone:337-762-3762
Practice Address - Fax:337-762-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA001261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1945251Medicaid
LA19-3997Medicare ID - Type Unspecified