Provider Demographics
NPI:1922566934
Name:LOUISIANA STATE UNIVERSITY
Entity Type:Organization
Organization Name:LOUISIANA STATE UNIVERSITY
Other - Org Name:PENNINGTON BIOMEDICAL RESEARCH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:LAVERGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-763-3101
Mailing Address - Street 1:6400 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-0102
Mailing Address - Country:US
Mailing Address - Phone:225-763-3101
Mailing Address - Fax:225-763-3102
Practice Address - Street 1:6400 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-0102
Practice Address - Country:US
Practice Address - Phone:225-763-3101
Practice Address - Fax:225-763-3102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUISIANA STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-08
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty