Provider Demographics
NPI:1841401817
Name:UNIVERSITY MEDICAL CENTER MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:UNIVERSITY MEDICAL CENTER MANAGEMENT CORPORATION
Other - Org Name:INTERIM LSU HOSPITAL OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NUESSLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-903-3000
Mailing Address - Street 1:1400 POYDRAS STREET
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2821
Mailing Address - Country:US
Mailing Address - Phone:504-903-1991
Mailing Address - Fax:504-903-1987
Practice Address - Street 1:1400 POYDRAS STREET
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2821
Practice Address - Country:US
Practice Address - Phone:504-903-1991
Practice Address - Fax:504-903-1987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.006727-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141336OtherPK