Provider Demographics
NPI:1093718157
Name:HAND SURGERY CENTER OF LOUISIANA LP
Entity Type:Organization
Organization Name:HAND SURGERY CENTER OF LOUISIANA LP
Other - Org Name:GREATER NEW ORLEANS SUGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:A
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CASC
Authorized Official - Phone:504-454-2017
Mailing Address - Street 1:3434 HOUMA BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4279
Mailing Address - Country:US
Mailing Address - Phone:504-454-2017
Mailing Address - Fax:504-454-2142
Practice Address - Street 1:3434 HOUMA BLVD
Practice Address - Street 2:STE 300
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4279
Practice Address - Country:US
Practice Address - Phone:504-454-2017
Practice Address - Fax:504-454-2142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA93261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
490004774OtherMEDICARE RAILROAD
LA1436569Medicaid
LA11033Medicare ID - Type Unspecified