1336762269 NPI number — LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER

Table of content: (NPI 1336762269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336762269 NPI number — LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUISIANA STATE UNIVERSITY HEALTH SCIENCES 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:
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:
1336762269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 735328
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:
75373-5328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-603-8027
Provider Business Mailing Address Fax Number:
318-866-9720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1505 KINGS HIGHWAY
Provider Second Line Business Practice Location Address:
2ND FLOOR BRI BUILDING
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71103-4228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-675-7195
Provider Business Practice Location Address Fax Number:
318-866-9720
Provider Enumeration Date:
05/27/2020

Additional Information

Authorized Official

Authorized Official Last Name:
OGLESBY
Authorized Official First Name:
LEISA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
EXECUTIVE DIRECTOR OF MEDICAL SERVI
Authorized Official Telephone Number:
318-675-7629

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)





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