Provider Demographics
NPI:1639642556
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 PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
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 1:6300 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-4037
Mailing Address - Country:US
Mailing Address - Phone:225-658-6770
Mailing Address - Fax:
Practice Address - Street 1:6300 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4037
Practice Address - Country:US
Practice Address - Phone:225-658-6770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy