1316074016 NPI number — EARL K. LONG MEDICAL CENTER

Table of content: (NPI 1316074016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316074016 NPI number — EARL K. LONG MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EARL K. LONG MEDICAL CENTER
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:
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:
1316074016
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:
5825 AIRLINE HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70805-2408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-958-1000
Provider Business Mailing Address Fax Number:
225-358-1003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5825 AIRLINE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70805-2408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-958-1000
Provider Business Practice Location Address Fax Number:
225-358-1003
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITHBURG
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
R
Authorized Official Title or Position:
VICE CHANCELLOR CEO
Authorized Official Telephone Number:
225-922-1474

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1203831 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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