Provider Demographics
NPI:1720201908
Name:LOUISIANA STATE UNIVERSITY AND A & M COLLEGE STUDENT HEALTH CENTER
Entity Type:Organization
Organization Name:LOUISIANA STATE UNIVERSITY AND A & M COLLEGE STUDENT HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:PERRET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-578-6271
Mailing Address - Street 1:INFIRMARY RD
Mailing Address - Street 2:LSU CAMPUS
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70803-2401
Mailing Address - Country:US
Mailing Address - Phone:225-578-6271
Mailing Address - Fax:225-578-0805
Practice Address - Street 1:INFIRMARY RD
Practice Address - Street 2:LSU CAMPUS
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70803-2401
Practice Address - Country:US
Practice Address - Phone:225-578-6271
Practice Address - Fax:225-578-0805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health