Provider Demographics
NPI:1851562813
Name:LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
Entity Type:Organization
Organization Name:LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
Other - Org Name:ALLIED HEALTH CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLIN MGMT SYSTEM
Authorized Official - Prefix:
Authorized Official - First Name:REVA
Authorized Official - Middle Name:MATTHIEW
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:318-813-2962
Mailing Address - Street 1:PO BOX 33932
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71130-3932
Mailing Address - Country:US
Mailing Address - Phone:318-813-2962
Mailing Address - Fax:318-813-2975
Practice Address - Street 1:1450 CLAIBORNE AVE
Practice Address - Street 2:SCHOOL OF ALLIED HEALTH PROFESSIONS
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4204
Practice Address - Country:US
Practice Address - Phone:318-813-2963
Practice Address - Fax:318-813-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1035777Medicaid