Provider Demographics
NPI:1912973090
Name:UNION GENERAL HOSPITAL
Entity Type:Organization
Organization Name:UNION GENERAL HOSPITAL
Other - Org Name:UNION GENERAL HOSPITAL DBA UNION GENERAL RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-368-7066
Mailing Address - Street 1:1025 MARION HWY
Mailing Address - Street 2:
Mailing Address - City:FARMERVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71241-9314
Mailing Address - Country:US
Mailing Address - Phone:318-368-9745
Mailing Address - Fax:318-368-0072
Practice Address - Street 1:1025 MARION HWY
Practice Address - Street 2:
Practice Address - City:FARMERVILLE
Practice Address - State:LA
Practice Address - Zip Code:71241-9314
Practice Address - Country:US
Practice Address - Phone:318-368-9745
Practice Address - Fax:318-368-0072
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNION GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-27
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1442089Medicaid
LA110484125BOtherBLUE CROSS BLUE SHIELD
LA1442089Medicaid
LA5CS82Medicare PIN