Provider Demographics
NPI:1104204692
Name:LOUISIANA DEPT. OF HEALTH AND HOSPITAL
Entity Type:Organization
Organization Name:LOUISIANA DEPT. OF HEALTH AND HOSPITAL
Other - Org Name:OFFICE OF PUBLIC HEALTH GENETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-342-6188
Mailing Address - Street 1:628 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-5342
Mailing Address - Country:US
Mailing Address - Phone:225-342-6188
Mailing Address - Fax:
Practice Address - Street 1:628 N 4TH ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-5342
Practice Address - Country:US
Practice Address - Phone:225-342-6188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1942221098Medicaid