Provider Demographics
NPI:1790966638
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:MR
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:318-283-3710
Mailing Address - Fax:318-239-8710
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:318-283-3600
Practice Address - Fax:318-239-8600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOREHOUSE GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-20
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1797138Medicaid
LA1797138Medicaid
LA5D096Medicare PIN