Provider Demographics
NPI:1295772259
Name:LAKEVIEW MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:LAKEVIEW MEDICAL CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-867-4446
Mailing Address - Street 1:95 JUDGE TANNER BLVD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7500
Mailing Address - Country:US
Mailing Address - Phone:985-867-3800
Mailing Address - Fax:985-867-4449
Practice Address - Street 1:95 JUDGE TANNER BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7500
Practice Address - Country:US
Practice Address - Phone:985-867-3800
Practice Address - Fax:985-867-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA60094OtherBCBS
LA1766836Medicaid
MS03578096Medicaid
166327100OtherUS DEPT LABOR
275768OtherHEALTHLINK
190177Medicare Oscar/Certification