Provider Demographics
NPI:1932492626
Name:LOUISIANA STATE UNIVERSITY SCHOOL OF MED IN NEW ORLEANS FACULTY GROU
Entity Type:Organization
Organization Name:LOUISIANA STATE UNIVERSITY SCHOOL OF MED IN NEW ORLEANS FACULTY GROU
Other - Org Name:LSU HEALTHCARE NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER RELATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLEEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:GAUTHREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-412-1835
Mailing Address - Street 1:1340 POYDRAS ST
Mailing Address - Street 2:SUITE 1640
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1221
Mailing Address - Country:US
Mailing Address - Phone:504-412-1100
Mailing Address - Fax:504-412-1954
Practice Address - Street 1:1340 POYDRAS ST
Practice Address - Street 2:SUITE 1640
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1221
Practice Address - Country:US
Practice Address - Phone:504-412-1100
Practice Address - Fax:504-412-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty