Provider Demographics
NPI:1912173352
Name:HOSPITAL SERVICE DISTRICT #2 OF LASALLE PARISH
Entity Type:Organization
Organization Name:HOSPITAL SERVICE DISTRICT #2 OF LASALLE PARISH
Other - Org Name:LASALLE FAMILY MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LANA
Authorized Official - Middle Name:B
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-992-9150
Mailing Address - Street 1:P.O. BOX 2780
Mailing Address - Street 2:
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342
Mailing Address - Country:US
Mailing Address - Phone:318-992-6311
Mailing Address - Fax:318-992-9245
Practice Address - Street 1:180 NINTH ST
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342-3900
Practice Address - Country:US
Practice Address - Phone:318-992-6311
Practice Address - Fax:318-992-9245
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL SERVICE DISTRICT #2 OF LASALLE PARISH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-06
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
LA231RHC-2261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
193481Medicare PIN