Provider Demographics
NPI:1992204218
Name:WOMAN'S HOSPITAL FOUNDATION
Entity Type:Organization
Organization Name:WOMAN'S HOSPITAL FOUNDATION
Other - Org Name:WOMAN'S HOSPITAL OUTPATIENT LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-924-8101
Mailing Address - Street 1:100 WOMANS WAY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5100
Mailing Address - Country:US
Mailing Address - Phone:225-924-8101
Mailing Address - Fax:225-924-8777
Practice Address - Street 1:100 WOMANS WAY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5100
Practice Address - Country:US
Practice Address - Phone:225-924-8101
Practice Address - Fax:225-924-8777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOMAN'S HOSPITAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACLIA19D0463039291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1734560Medicaid