Provider Demographics
NPI:1831183748
Name:HOMER MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:HOMER MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-927-2024
Mailing Address - Street 1:620 EAST COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-3202
Mailing Address - Country:US
Mailing Address - Phone:318-927-2024
Mailing Address - Fax:318-927-9212
Practice Address - Street 1:620 EAST COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-3202
Practice Address - Country:US
Practice Address - Phone:318-927-2024
Practice Address - Fax:318-927-9212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206282N00000X
206282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1705802Medicaid
LA1734403Medicaid
LA1402541Medicaid
LA1799645Medicaid
LA19S114Medicare Oscar/Certification
LA19U114Medicare Oscar/Certification
LA1734403Medicaid
LA197259Medicare Oscar/Certification
LA5D095Medicare ID - Type UnspecifiedPHYSICIAN