Provider Demographics
NPI:1104991215
Name:ACH BAYNE-JONES-FT JOHNSON
Entity type:Organization
Organization Name:ACH BAYNE-JONES-FT JOHNSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-653-2315
Mailing Address - Street 1:1585 THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:FORT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71459-6000
Mailing Address - Country:US
Mailing Address - Phone:337-531-3482
Mailing Address - Fax:
Practice Address - Street 1:1585 THIRD STREET
Practice Address - Street 2:
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459-6000
Practice Address - Country:US
Practice Address - Phone:337-531-3118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACH BAYNE-JONES-FT JOHNSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-22
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QM1100X, 261QM1101X
2865M2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
No261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
No261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA61320OtherBCBS LA PROVIDER #
LA19050FMedicare Oscar/Certification
LA19050FMedicare PIN
OTH000Medicare UPIN
LA61320OtherBCBS LA PROVIDER #