Provider Demographics
NPI:1336762269
Name:LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
Entity Type:Organization
Organization Name:LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
Other - Org Name:EMERGING VIRAL THREAT LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF MEDICAL SERVI
Authorized Official - Prefix:
Authorized Official - First Name:LEISA
Authorized Official - Middle Name:P
Authorized Official - Last Name:OGLESBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-675-7629
Mailing Address - Street 1:PO BOX 735328
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-5328
Mailing Address - Country:US
Mailing Address - Phone:318-603-8027
Mailing Address - Fax:318-866-9720
Practice Address - Street 1:1505 KINGS HIGHWAY
Practice Address - Street 2:2ND FLOOR BRI BUILDING
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-675-7195
Practice Address - Fax:318-866-9720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-27
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory