Provider Demographics
NPI:1508066283
Name:LOUISISNA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS FACULTY G
Entity Type:Organization
Organization Name:LOUISISNA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS FACULTY G
Other - Org Name:LSU HEALTHCARE NETWORK LAB - PERDIDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
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:PO BOX 919100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-9100
Mailing Address - Country:US
Mailing Address - Phone:855-631-6628
Mailing Address - Fax:
Practice Address - Street 1:1901 PERDIDO STREET
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112
Practice Address - Country:US
Practice Address - Phone:504-568-6038
Practice Address - Fax:504-412-1505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LSU HEALTHCARE NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-20
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19-HL-02OtherMEDICARE PROVIDER NUMBER