Provider Demographics
NPI:1275830655
Name:MD2U LOUISIANA LLC
Entity Type:Organization
Organization Name:MD2U LOUISIANA LLC
Other - Org Name:MD2U THE LEADER IN MEDICAL HOUSE CALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-416-1851
Mailing Address - Street 1:PO BOX 7219
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40257-0219
Mailing Address - Country:US
Mailing Address - Phone:502-327-9410
Mailing Address - Fax:502-742-3767
Practice Address - Street 1:201 SAINT CHARLES AVE
Practice Address - Street 2:STE. 2500
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70170-1000
Practice Address - Country:US
Practice Address - Phone:866-460-3567
Practice Address - Fax:502-742-3767
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MD2U MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-19
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19D2045836OtherCLIA - CERTIFICATE OF WAIVER
LA5DT50Medicare PIN