Provider Demographics
NPI:1245271063
Name:LEONARD J CHABERT MEDICAL CENTER
Entity type:Organization
Organization Name:LEONARD J CHABERT MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE CHANCELLOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-922-0775
Mailing Address - Street 1:1978 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70363-7055
Mailing Address - Country:US
Mailing Address - Phone:985-873-2200
Mailing Address - Fax:985-873-1262
Practice Address - Street 1:1978 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70363-7055
Practice Address - Country:US
Practice Address - Phone:985-873-2200
Practice Address - Fax:985-873-1262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEONARD J CHABERT MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-10
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA61090OtherBCBS PSYCH
LA1705136Medicaid
LA61090OtherBCBS PSYCH