Provider Demographics
NPI:1316390982
Name:LSU
Entity Type:Organization
Organization Name:LSU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOUSE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIOLAIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-261-6789
Mailing Address - Street 1:2390 W CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-4205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2390 W CONGRESS ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4205
Practice Address - Country:US
Practice Address - Phone:337-261-6789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital
No282N00000XHospitalsGeneral Acute Care Hospital