Provider Demographics
NPI:1992207294
Name:MOREHOUSE GENERAL HOSPITAL
Entity Type:Organization
Organization Name:MOREHOUSE GENERAL HOSPITAL
Other - Org Name:MOREHOUSE FAMILY MEDICINE RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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 293
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71221-0293
Mailing Address - Country:US
Mailing Address - Phone:318-283-3622
Mailing Address - Fax:318-239-8622
Practice Address - Street 1:430 SOUTH VINE ST.
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220
Practice Address - Country:US
Practice Address - Phone:318-283-3970
Practice Address - Fax:318-239-8970
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOREHOUSE GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-02
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health