Provider Demographics
NPI:1942889852
Name:LSUMC-S FAMILY PRACTICE MEDICAL CENTER IN ALEXANDRIA
Entity Type:Organization
Organization Name:LSUMC-S FAMILY PRACTICE MEDICAL CENTER IN ALEXANDRIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIR FOR MEDICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LEISA
Authorized Official - Middle Name:P
Authorized Official - Last Name:OGLESBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-675-7629
Mailing Address - Street 1:PO BOX 735328
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-5328
Mailing Address - Country:US
Mailing Address - Phone:318-441-1030
Mailing Address - Fax:318-441-1050
Practice Address - Street 1:301 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8411
Practice Address - Country:US
Practice Address - Phone:318-441-1030
Practice Address - Fax:318-441-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty