Provider Demographics
NPI:1225149677
Name:LOUISIANA UROLOGY, LLC
Entity Type:Organization
Organization Name:LOUISIANA UROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FELISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-766-8100
Mailing Address - Street 1:8080 BLUEBONNET BLVD
Mailing Address - Street 2:STE 3000
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7827
Mailing Address - Country:US
Mailing Address - Phone:225-766-8100
Mailing Address - Fax:225-408-6896
Practice Address - Street 1:8080 BLUEBONNET BLVD
Practice Address - Street 2:STE 3000
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-7827
Practice Address - Country:US
Practice Address - Phone:225-766-8100
Practice Address - Fax:225-408-6896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1944301Medicaid
LA1944301Medicaid
LA1944301Medicaid
5D690Medicare ID - Type Unspecified