1780075499 NPI number — SOUTHEASTERN LOUISIANA UNIVERISITY

Table of content: MARK E. HAROUSSEAU MD (NPI 1417488099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780075499 NPI number — SOUTHEASTERN LOUISIANA UNIVERISITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHEASTERN LOUISIANA UNIVERISITY
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:
1780075499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 650850
Provider Second Line Business Mailing Address:
DEPT. 1011
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75265-0850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-555-9073
Provider Business Mailing Address Fax Number:
972-367-3452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 GALLOWAY DR
Provider Second Line Business Practice Location Address:
DUGAS CENTER
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70402-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-549-5133
Provider Business Practice Location Address Fax Number:
972-367-3451
Provider Enumeration Date:
02/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
IRWIN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
ASST. DIRECTOR FOR SPORTS MEDICINE
Authorized Official Telephone Number:
985-549-5133

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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