Provider Demographics
NPI:1851393458
Name:COVINGTON -AMG SPECIALTY HOSPITAL, LLC
Entity Type:Organization
Organization Name:COVINGTON -AMG SPECIALTY HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AUGUST
Authorized Official - Middle Name:
Authorized Official - Last Name:RANTZ
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:337-269-9566
Mailing Address - Street 1:101 LA RUE FRANCE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3138
Mailing Address - Country:US
Mailing Address - Phone:337-269-9566
Mailing Address - Fax:337-234-1075
Practice Address - Street 1:195 HIGHLAND PARK ENTRANCE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7164
Practice Address - Country:US
Practice Address - Phone:985-867-3977
Practice Address - Fax:985-867-3979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA526282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1701963Medicaid
LA5CW01OtherMEDICARE PTN
LA1701963Medicaid
LA192051Medicare Oscar/Certification