Provider Demographics
NPI:1205866282
Name:UROLOGY ASSOCIATES OF LOUISIANA LLC
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES OF LOUISIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLIEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-454-0755
Mailing Address - Street 1:4228 HOUMA BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006
Mailing Address - Country:US
Mailing Address - Phone:504-454-0755
Mailing Address - Fax:504-780-2558
Practice Address - Street 1:4228 HOUMA BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-454-0755
Practice Address - Fax:504-780-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1798266Medicaid
LACN7495Medicare PIN
LA5F602Medicare PIN