1104857671 NPI number — LIFEMARK HOSPITALS OF LOUISIANA, INC.

Table of content: KARI WILSON MA. LPC (NPI 1619746310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104857671 NPI number — LIFEMARK HOSPITALS OF LOUISIANA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFEMARK HOSPITALS OF LOUISIANA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104857671
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 676733
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75267-6733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-387-6444
Provider Business Mailing Address Fax Number:
504-464-8062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 W ESPLANADE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70065-2467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-468-8600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RABE
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
VP OF TAXATION, TENET HEALTHCARE
Authorized Official Telephone Number:
469-893-2530

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  300 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 60779 . This is a "BCBS OF LOUISIANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1744611 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1705551 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000449 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1744701 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 190206B000000 . This is a "SECTION 1011" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33721 . This is a "BCBS OF LOUISIANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 84889 . This is a "COVENTRY HEALTH CARE LOUI" identifier . This identifiers is of the category "OTHER".




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