Provider Demographics
NPI:1689977589
Name:MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS
Entity Type:Organization
Organization Name:MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS
Other - Org Name:ILH-L.B. LANDRY COMMUNITY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-903-4907
Mailing Address - Street 1:2021 PERDIDO ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1352
Mailing Address - Country:US
Mailing Address - Phone:504-903-5153
Mailing Address - Fax:504-680-0203
Practice Address - Street 1:1200 L B LANDRY AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-2657
Practice Address - Country:US
Practice Address - Phone:504-308-3550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-15
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2132342Medicaid
LA190005Medicare UPIN