Provider Demographics
NPI:1669815429
Name:BAYNE-JONES ARMY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:BAYNE-JONES ARMY COMMUNITY HOSPITAL
Other - Org Name:PREVENTIVE MEDICINE-POLK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-653-3220
Mailing Address - Street 1:1585 3RD ST
Mailing Address - Street 2:BLDG 285
Mailing Address - City:FORT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71459-5102
Mailing Address - Country:US
Mailing Address - Phone:337-531-3482
Mailing Address - Fax:
Practice Address - Street 1:8103 GEORGIA AVENUE
Practice Address - Street 2:BLDG 3516
Practice Address - City:FT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459
Practice Address - Country:US
Practice Address - Phone:337-313-4730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAYNE-JONES ARMY COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-11
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
1104991215OtherPARENT FACILITY NPI