Provider Demographics
NPI:1356363188
Name:ST ANNE GENERAL HOSPITAL
Entity type:Organization
Organization Name:ST ANNE GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOURGEOIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:985-537-6841
Mailing Address - Street 1:4608 HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394-2623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4608 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2623
Practice Address - Country:US
Practice Address - Phone:985-537-6841
Practice Address - Fax:985-537-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA225207P00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G2660OtherBLUE CROSS
04759OtherBLUE CROSS
LA1797430Medicaid
G2660OtherBLUE CROSS