Organization
GREEN CLINIC SURGICAL HOSPITAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES MCCLUNG (ADMINISTRATOR)
(318) 232-7186
Entity
Organization
Contact information
Practice address
1118 S FARMERVILLE ST, RUSTON, LA 71270-5914
(318) 232-7700
(318) 232-1092
Mailing address
1118 S FARMERVILLE ST, RUSTON, LA 71270-5914
(318) 232-7700
(318) 232-1092
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
515
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1702676
—
LA
01
—
60643
BCBS PROVIDER NO
LA
Enumeration date
10/12/2006
Last updated
01/14/2008
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