Provider Demographics
NPI:1336103001
Name:PERKINS PLAZA AMBULATORY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:PERKINS PLAZA AMBULATORY SURGERY CENTER LLC
Other - Org Name:LAKE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-408-5548
Mailing Address - Street 1:7145 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4322
Mailing Address - Country:US
Mailing Address - Phone:225-765-3111
Mailing Address - Fax:225-765-3114
Practice Address - Street 1:7145 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4322
Practice Address - Country:US
Practice Address - Phone:225-765-3111
Practice Address - Fax:225-765-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA116261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1152234Medicaid
LA1152234Medicaid
LA1152234Medicaid