Provider Demographics
NPI:1295776276
Name:EARL K LONG MEDICAL CENTER
Entity type:Organization
Organization Name:EARL K LONG MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING 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:MD
Authorized Official - Phone:225-922-0775
Mailing Address - Street 1:5825 AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-2408
Mailing Address - Country:US
Mailing Address - Phone:225-358-1000
Mailing Address - Fax:225-358-1003
Practice Address - Street 1:5825 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-2408
Practice Address - Country:US
Practice Address - Phone:225-358-1000
Practice Address - Fax:225-358-1003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EARL K LONG MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-09
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1705071Medicaid
LA61029OtherBCBS PSYCH
LA19S122Medicare Oscar/Certification