1619982378 NPI number — SOUTHEAST LOUISIANA VETERANS HEALTH CARE SYSTEM

Table of content: (NPI 1619982378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619982378 NPI number — SOUTHEAST LOUISIANA VETERANS HEALTH CARE SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHEAST LOUISIANA VETERANS HEALTH CARE SYSTEM
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:
1619982378
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:
10348 MARANATHA ACRES
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT AMANT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70774-4425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-761-6792
Provider Business Mailing Address Fax Number:
225-761-6070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7968 ESSEN PARK
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:
70809-7439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-761-6700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUTH
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSOCIATE CHIEF OF STAFF CLINICS
Authorized Official Telephone Number:
504-568-0811

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  AP03606 , 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)





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