Provider Demographics
NPI:1477582526
Name:LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS FACULTY G
Entity Type:Organization
Organization Name:LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS FACULTY G
Other - Org Name:LSU HEALTHCARE NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:A/R MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ATARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCAVOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-412-1819
Mailing Address - Street 1:1542 TULANE AVE
Mailing Address - Street 2:SUITE 123-HCN
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2865
Mailing Address - Country:US
Mailing Address - Phone:504-412-1819
Mailing Address - Fax:504-412-1954
Practice Address - Street 1:1542 TULANE AVE
Practice Address - Street 2:SUITE 123-HCN
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2865
Practice Address - Country:US
Practice Address - Phone:504-412-1819
Practice Address - Fax:504-412-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1017817Medicaid
LA1444014Medicaid
LA1945846Medicaid
LA1945862Medicaid
LA1169269Medicaid
LA1442615Medicaid
LA1444944Medicaid
LA1945854Medicaid
MS09014817Medicaid
LA1167347Medicaid
AL529800160Medicaid
LACN2133Medicare PIN
LA1444944Medicaid
LA1444014Medicaid
LA1945854Medicaid
LA1167347Medicaid
LA1293240001Medicare PIN