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Hospital Service District No 1 Parish of Avoyelles State of la

Organization Active NPI Rural Health Clinic/Center · Bunkie, LA

NPI 1811942279 · NPPES record last updated Nov 9, 2017

Key facts

NPI
1811942279
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
License
184RHC-1 (LA)
Legal business name
HOSPITAL SERVICE DISTRICT NO 1 PARISH OF AVOYELLES STATE OF LA
Practice address
109 N Lexington Ave
Bunkie, LA 71322-1619
Phone
(318) 346-7283
NPI assigned
May 24, 2006
Organization subpart
Yes
Parent organization (as reported)
HOSPITAL SERVICE DISTRICT NO 1 PARISH OF AVOYELLES STATE OF LOUISIANA

Authorized official

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

Owned or controlled facilities with NPI records 2

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

Other NPIs on the same Medicare enrollment 5

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

Other NPIs with the same Medicare PAC ID 4

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

Corporate family (same tax ID) 7

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

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

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 29

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D0887696Bunkie General Hospital Rural Health
109 North Lexington, Bunkie, LA 71322		Certificate of waiverDec 10, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in LA, AR

Rural health clinic certification: CCN 193987

Legal name
HOSPITAL SERVICE DISTRICT NO 1 PARISH OF AVOYELLES STATE OF LA
Doing business as
BUNKIE GENERAL RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 1, 1994
Last certification
Sep 27, 2021
Ownership / control type
Non-profit – church related
Organization structure
Other · Non-profit
Enrollment address
109 N. Lexington Ave
Bunkie Rural Health Clinic
Bunkie, LA 71322-0380
Related CCNs
191311

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 Officer May 7, 2007
W-2 Managing Employee
Ceo		 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 Hospital
Bunkie, LA · CCN 191311		 Hospital Operational/Managerial Control (100%) May 7, 2007
Bunkie Homecare
Bunkie, LA · CCN 197114		 Home health agency 5% Or Greater Direct Ownership Interest (33%) Mar 1, 2004

Medicare enrollment records

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
O20100618000760 AR Part a Provider - Rural Health Clinic 3375440910 Practice locations: Bunkie, LA

National Provider Directory

Tax ID family
Bunkie Gen Hosp Rural H (8 organizations share this tax ID)
Part of
Bunkie Gen Hosp Rural H

Locations

427 Evergreen St
Bunkie, LA 71322
Phone (318) 346-6681

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 184RHC-1 LA Yes

Addresses

Primary practice location

109 N Lexington Ave
Bunkie, LA 71322-1619

Mailing address

PO Box 380
Bunkie, LA 71322-0380
Phone (318) 346-7283

Other identifiers

IdentifierTypeStateIssuer
1943762MedicaidLA
184RHC-1OtherLASTATE LICENSE #

Other providers in Bunkie, LA

All providers in Bunkie, LA · Rural Health Clinic/Center in Louisiana

Sources for this page

Verify at the official NPI Registry.