1508066283 NPI number — LOUISISNA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS FACULTY G

Table of content: (NPI 1508066283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508066283 NPI number — LOUISISNA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS FACULTY G

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUISISNA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS FACULTY G
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:
LSU HEALTHCARE NETWORK LAB - PERDIDO
Provider Other Organization Name Type Code:
3
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:
1508066283
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 919100
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:
75391-9100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-631-6628
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 PERDIDO STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-568-6038
Provider Business Practice Location Address Fax Number:
504-412-1505
Provider Enumeration Date:
07/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCAVOY
Authorized Official First Name:
ATARA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
504-412-1819

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 19-HL-02 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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