Provider Demographics
NPI:1013013408
Name:LGH OB-GYN CLINIC 2
Entity Type:Organization
Organization Name:LGH OB-GYN CLINIC 2
Other - Org Name:OBSTETRICS & GYNECOLOGY OF RUSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-254-2453
Mailing Address - Street 1:411 EAST VAUGHN AVE.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270
Mailing Address - Country:US
Mailing Address - Phone:318-255-3223
Mailing Address - Fax:318-255-3181
Practice Address - Street 1:411 EAST VAUGHN AVE.
Practice Address - Street 2:SUITE 201
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270
Practice Address - Country:US
Practice Address - Phone:318-255-3223
Practice Address - Fax:318-255-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201086207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA33779OtherCONTROLLED SUBSTANCE
LAMD.201086OtherLA LICENSE NUMBER
LAMD.201086OtherLA LICENSE NUMBER
GABG8736160OtherDEA