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Organization Active NPI

Homer Memorial Hospital

Doing business as Claiborne Memorial Medical Center

  • Emergency Medicine Physician
  • Homer, LA
National Provider Identifier
1609066646
Registry record updated Feb 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
206 Issued in LA
Legal business name
HOMER MEMORIAL HOSPITAL
Doing business as
Claiborne Memorial Medical Center
Practice address
620 East College St.
Homer, LA 71040
Phone
(318) 927-2024
Fax
(318) 927-9212
NPI assigned
Jul 26, 2007
Last updated
Feb 3, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
HOMER MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 3, 2026

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

Authorized official

Name
Tina Haynes, RHIA
Title
Ceo
Phone
(318) 927-2024

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Substance Abuse Rehabilitation Facility 324500000X
Certified Registered Nurse Anesthetist 367500000X 206 LA
Emergency Medicine Physician 207P00000X 206 LA Primary

Addresses

Primary practice location

620 East College St.
Homer, LA 71040

Mailing address

PO Box 809
620 E College St.
Homer, LA 71040
Phone (318) 927-2024

Other practice location 1

912 W Main St
Homer, LA 71040-3328
Phone (318) 927-2024

Other identifiers 3

IdentifierTypeStateIssuer
04802OtherLABLUE CROSS
1705802MedicaidLA
1799645MedicaidLA

Other names 1

  • Claiborne Memorial Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040803000291 LA Part B Supplier - Clinic/Group Practice 1456322692 Receives reassigned benefits from 46 practitioners
1 other NPI on this enrollment
Practice locations: Homer, LA; Minden, LA

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Homer Memorial Hosp Beh13 organizations share this tax ID, including this one
Part of
Homer Memorial Hosp Beh

Other organizations with this tax ID 12

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

Locations

104 Morris Cir
Homer, LA 71040
Phone (318) 927-1110

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Homer Medical ClinicHomer, LA, CCN 198507 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 30, 2015

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 47

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.

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770076800000",
    "number": "1609066646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 809",
            "address_2": "620 E COLLEGE ST.",
            "city": "HOMER",
            "state": "LA",
            "postal_code": "71040",
            "telephone_number": "318-927-2024",
            "fax_number": "318-972-9212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 EAST COLLEGE ST.",
            "city": "HOMER",
            "state": "LA",
            "postal_code": "71040",
            "telephone_number": "318-927-2024",
            "fax_number": "318-927-9212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "912 W Main St",
            "address_purpose": "LOCATION",
            "city": "Homer",
            "state": "LA",
            "postal_code": "710403328",
            "country_code": "US",
            "telephone_number": "318-927-2024",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HOMER MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOMER MEMORIAL HOSPITAL",
        "enumeration_date": "2007-07-26",
        "last_updated": "2026-02-03",
        "certification_date": "2026-02-03",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-927-2024",
        "authorized_official_credential": "RHIA"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "LA",
            "license": "206",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "LA",
            "license": "206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "04802",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1705802",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1799645",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Claiborne Memorial Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Claiborne Memorial Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Homer, LA

Sources for this page

Verify at the official NPI Registry.