Provider Demographics
NPI:1619458247
Name:ABBEVILLE GENERAL HOSPITAL
Entity Type:Organization
Organization Name:ABBEVILLE GENERAL HOSPITAL
Other - Org Name:ABBEVILLE URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUS OFF AND PT ACCESS
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA, CCS
Authorized Official - Phone:337-898-6525
Mailing Address - Street 1:118 N HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-4039
Mailing Address - Country:US
Mailing Address - Phone:337-893-5466
Mailing Address - Fax:337-893-2801
Practice Address - Street 1:2421 ALONZO STREET
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4008
Practice Address - Country:US
Practice Address - Phone:337-892-6919
Practice Address - Fax:337-892-6920
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABBEVILLE GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-22
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA756231OtherMEDICARE PTAN#
LA2488368Medicaid