Provider Demographics
NPI:1558382507
Name:UNIVERSITY OF NEW ORLEANS METRO COLLEGE
Entity Type:Organization
Organization Name:UNIVERSITY OF NEW ORLEANS METRO COLLEGE
Other - Org Name:UNO STUDENT HEALTH SERVICES PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF PHCY
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:504-280-7074
Mailing Address - Street 1:2000 LAKESHORE DR
Mailing Address - Street 2:UC 238
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70148-0001
Mailing Address - Country:US
Mailing Address - Phone:504-280-7074
Mailing Address - Fax:504-280-5405
Practice Address - Street 1:2000 LAKESHORE DR
Practice Address - Street 2:UC 238
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70148-0001
Practice Address - Country:US
Practice Address - Phone:504-280-7074
Practice Address - Fax:504-280-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2625IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1260801Medicaid
1927168OtherNCPDP PROVIDER IDENTIFICATION NUMBER