Provider Demographics
NPI:1821465576
Name:LAKE SURGICAL HOSPITAL SLIDELL, LLC
Entity Type:Organization
Organization Name:LAKE SURGICAL HOSPITAL SLIDELL, LLC
Other - Org Name:SOUTHERN SURGICAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PISCIOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-641-0600
Mailing Address - Street 1:1700 LINDBERG DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8062
Mailing Address - Country:US
Mailing Address - Phone:985-661-2105
Mailing Address - Fax:985-643-7677
Practice Address - Street 1:1700 LINDBERG DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8062
Practice Address - Country:US
Practice Address - Phone:985-661-2105
Practice Address - Fax:985-643-7677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital