Provider Demographics
NPI:1821460254
Name:PROFESSIONAL HOSPITALIST OF LOUISIANA, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL HOSPITALIST OF LOUISIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VERRETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-826-9655
Mailing Address - Street 1:PO BOX 1536
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-1536
Mailing Address - Country:US
Mailing Address - Phone:504-826-9655
Mailing Address - Fax:
Practice Address - Street 1:8050 W JUDGE PEREZ DR STE 2300
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-1738
Practice Address - Country:US
Practice Address - Phone:504-826-9655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care