1457396095 NPI number — SOUTHEAST LOUISIANA VETERANS HEALTH CARE SYSTEM

Table of content: (NPI 1457396095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457396095 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:
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:
1457396095
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:
1101 S MORRISON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMMOND
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70403-5409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-340-7816
Provider Business Mailing Address Fax Number:
985-340-3834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 S MORRISON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70403-5409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-340-7816
Provider Business Practice Location Address Fax Number:
985-340-3834
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUSSELL
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
STAFF CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
985-340-7816

Provider Taxonomy Codes

  • Taxonomy code: 261QV0200X , with the licence number:  600 , 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)





Copyright © 2007-2025 www.npivalidator.com