Provider Demographics
NPI:1790744506
Name:ABBEVILLE GENERAL HOSPITAL
Entity Type:Organization
Organization Name:ABBEVILLE GENERAL HOSPITAL
Other - Org Name:ABBEVILLE GENERAL HOSPITAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-893-5466
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 1:2419 ALONZO ST
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:337-892-0630
Practice Address - Fax:337-893-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA160 RHC-1261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1448087Medicaid
LA1448087Medicaid
LA=========EOtherBCBS PROVIDER #