NPIMap

Organization Active NPI

Hospital Service District No 1 Parish of Avoyelles State of Louisiana

  • Rural Health Clinic/Center
  • Bunkie, LA
National Provider Identifier
1073568366
Registry record updated Nov 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
184RHC-2 Issued in LA
Legal business name
HOSPITAL SERVICE DISTRICT NO 1 PARISH OF AVOYELLES STATE OF LOUISIANA
Practice address
510 S Cottonwood St
Bunkie, LA 71322-1135
Phone
(318) 346-3339
NPI assigned
May 24, 2006
Last updated
Nov 9, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
HOSPITAL SERVICE DISTRICT NO 1 PARISH OF AVOYELLES STATE OF LOUISIANAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 9, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Latrice Williams
Title
Business Office Manager
Phone
(318) 346-6681

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 184RHC-2 LA Primary

Addresses

Primary practice location

510 S Cottonwood St
Bunkie, LA 71322-1135

Mailing address

PO Box 380
Bunkie, LA 71322-0380
Phone (318) 346-6681

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031212000761 LA Part B Supplier - Clinic/Group Practice 3375440910 Receives reassigned benefits from 43 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bunkie, LA; Marksville, LA
O20050608000701 LA Part A Provider - Rural Health Clinic 3375440910 Practice locations: Bunkie, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073568366. Details of each certification follow.

Rural health clinic certification: CCN 193460

Legal name
HOSPITAL SERVICE DISTRICT NO 1 PARISH OF AVOYELLES STATE OF LA
Doing business as
FAMILY CARE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 21, 2005
Last certification
Mar 9, 2018
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
510 South Cottonwood Street
Bunkie, LA 71322-0380
Related CCNs
191311

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D1084942Bunkie General Family Care Clinic510 South Cottonwood Street, Bunkie, LA 71322Certificate of waiverJun 5, 2028

National Provider Directory

National Provider Directory
Tax ID family
Hospital SVC District No 18 organizations share this tax ID, including this one
Part of
Hospital SVC District No 1

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Linda Deville Individual Corporate OfficerCeo May 7, 2007
W-2 Managing EmployeeCeo Dec 8, 2016

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Bunkie General HospitalBunkie, LA, CCN 191311 Hospital Operational/Managerial Control (100%) May 7, 2007
Bunkie HomecareBunkie, LA, CCN 197114 Home health agency 5% Or Greater Direct Ownership Interest (33%) Mar 1, 2004

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510185600000",
    "number": "1073568366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 380",
            "city": "BUNKIE",
            "state": "LA",
            "postal_code": "713220380",
            "telephone_number": "318-346-6681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 S COTTONWOOD ST",
            "city": "BUNKIE",
            "state": "LA",
            "postal_code": "713221135",
            "telephone_number": "318-346-3339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL SERVICE DISTRICT NO 1 PARISH OF AVOYELLES STATE OF LOUISIANA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOSPITAL SERVICE DISTRICT NO 1 PARISH OF AVOYELLES  STATE OF LOUISIANA",
        "enumeration_date": "2006-05-24",
        "last_updated": "2017-11-09",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "LATRICE",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "318-346-6681"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "LA",
            "license": "184RHC-2",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bunkie, LA

Sources for this page

Verify at the official NPI Registry.