Provider Demographics
NPI:1831193499
Name:HOSPITAL SERVICE DISTRICT NO 2 OF PARISH OF BEAUREGARD STATE OF LA
Entity type:Organization
Organization Name:HOSPITAL SERVICE DISTRICT NO 2 OF PARISH OF BEAUREGARD STATE OF LA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:337-462-7100
Mailing Address - Street 1:600 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-4942
Mailing Address - Country:US
Mailing Address - Phone:337-462-7100
Mailing Address - Fax:
Practice Address - Street 1:600 S PINE ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4942
Practice Address - Country:US
Practice Address - Phone:337-462-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA155282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1720038Medicaid
LA60794OtherBLUE CROSS PROVIDER NO.
LA720491106001OtherCHAMPUS UB92 PROVIDER NO.
LA720491106007OtherCHAMPUS 1500 PROVIDER NO.
LA720491106002OtherCHAMPUS SNF PROVIDER NO.
LA19U050Medicare Oscar/Certification
LA720491106001OtherCHAMPUS UB92 PROVIDER NO.