Provider Demographics
NPI:1073689667
Name:LOUISIANA DEPARTMENT OF HEALTH - OFFICE OF PUBLIC HEALTH
Entity Type:Organization
Organization Name:LOUISIANA DEPARTMENT OF HEALTH - OFFICE OF PUBLIC HEALTH
Other - Org Name:IMMUNIZATION
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CROTWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-568-3420
Mailing Address - Street 1:PO BOX 61979
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70161-1979
Mailing Address - Country:US
Mailing Address - Phone:504-568-2600
Mailing Address - Fax:504-568-8200
Practice Address - Street 1:1450 POYDRAS ST STE 1945
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1227
Practice Address - Country:US
Practice Address - Phone:504-568-3420
Practice Address - Fax:504-568-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2302175Medicaid