Provider Demographics
NPI:1164464095
Name:LAFOURCHE PARISH HOSPITAL SERVICE DISTRICT NO. 1
Entity Type:Organization
Organization Name:LAFOURCHE PARISH HOSPITAL SERVICE DISTRICT NO. 1
Other - Org Name:LADY OF THE SEA UROLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PRACTICE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:TAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAFONT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:985-325-9300
Mailing Address - Street 1:200 W 134TH PL
Mailing Address - Street 2:3RD FLOOR NORTH
Mailing Address - City:CUT OFF
Mailing Address - State:LA
Mailing Address - Zip Code:70345-4143
Mailing Address - Country:US
Mailing Address - Phone:985-325-2676
Mailing Address - Fax:985-632-2680
Practice Address - Street 1:200 W 134TH PL
Practice Address - Street 2:3RD FLOOR NORTH
Practice Address - City:CUT OFF
Practice Address - State:LA
Practice Address - Zip Code:70345-4143
Practice Address - Country:US
Practice Address - Phone:985-325-2676
Practice Address - Fax:985-632-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CJ00Medicare ID - Type Unspecified