Provider Demographics
NPI:1982828612
Name:HOSPITAL SERVICE DISTRICT 2 OF LASALLE
Entity Type:Organization
Organization Name:HOSPITAL SERVICE DISTRICT 2 OF LASALLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:NUNNALLY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:318-992-6627
Mailing Address - Street 1:PO BOX 13524
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-3524
Mailing Address - Country:US
Mailing Address - Phone:318-445-4477
Mailing Address - Fax:
Practice Address - Street 1:139 9TH STREET
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342-3901
Practice Address - Country:US
Practice Address - Phone:318-992-6627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1542164Medicaid
LA=========0OtherBLUE CROSS BLUE SHIELD
LA=========0OtherBLUE CROSS BLUE SHIELD