Provider Demographics
NPI:1912178245
Name:LSUHSC NEW ORLEANS PHYSICIANS
Entity Type:Organization
Organization Name:LSUHSC NEW ORLEANS PHYSICIANS
Other - Org Name:MCMAIN SECONDARY SCHOOL SCHOOL-BASED CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:ASST. BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEONE
Authorized Official - Middle Name:
Authorized Official - Last Name:COE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-896-2798
Mailing Address - Street 1:433 BOLIVAR ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-7021
Mailing Address - Country:US
Mailing Address - Phone:504-359-1120
Mailing Address - Fax:504-861-1780
Practice Address - Street 1:5712 S CLAIBORNE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-4999
Practice Address - Country:US
Practice Address - Phone:504-359-1120
Practice Address - Fax:504-861-1780
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-14
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19D1059911305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1351482Medicaid