Provider Demographics
NPI:1184664534
Name:LOUISIANA AVENUE MEDICAL CENTER INC
Entity Type:Organization
Organization Name:LOUISIANA AVENUE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:504-284-3866
Mailing Address - Street 1:4301 ELYSIAN FIELDS AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-7404
Mailing Address - Country:US
Mailing Address - Phone:504-284-3866
Mailing Address - Fax:504-284-3869
Practice Address - Street 1:4301 ELYSIAN FIELDS AVENUE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-7404
Practice Address - Country:US
Practice Address - Phone:504-284-3866
Practice Address - Fax:504-284-3869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1942421Medicaid
LA1942421Medicaid