Provider Demographics
NPI:1326249459
Name:HOSPITAL SERVICE DISTRICT 1 OF EAST BATON ROUGE PARISH
Entity Type:Organization
Organization Name:HOSPITAL SERVICE DISTRICT 1 OF EAST BATON ROUGE PARISH
Other - Org Name:LANE REGIONAL MEDICAL CENTER-LANE WOUND CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-658-4303
Mailing Address - Street 1:4917 WEST PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-4069
Mailing Address - Country:US
Mailing Address - Phone:225-658-4110
Mailing Address - Fax:225-658-4108
Practice Address - Street 1:4917 WEST PARK DRIVE
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4069
Practice Address - Country:US
Practice Address - Phone:225-658-4110
Practice Address - Fax:225-658-4108
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL SERVICE DISTRICT 1 OF
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-29
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA163WW0000X, 2083P0011X
207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1796662Medicaid
LA1796662Medicaid
LA5C237Medicare UPIN