1366721409 NPI number — MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366721409 NPI number — MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS
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:
1366721409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2021 PERDIDO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70112-1352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-903-5153
Provider Business Mailing Address Fax Number:
504-680-0203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2025 GRAVIER 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:
504-903-2373
Provider Business Practice Location Address Fax Number:
504-903-1163
Provider Enumeration Date:
08/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
TOWNSEND
Authorized Official First Name:
ROXANE
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
INTERIM CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
504-903-4907

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  191 , 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: 1765651 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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