Provider Demographics
NPI:1396872545
Name:MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS
Entity type:Organization
Organization Name:MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE CHANCELLOR CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITHBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-922-1474
Mailing Address - Street 1:2021 PERDIDO ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1352
Mailing Address - Country:US
Mailing Address - Phone:504-903-3000
Mailing Address - Fax:504-903-3580
Practice Address - Street 1:2021 PERDIDO ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1352
Practice Address - Country:US
Practice Address - Phone:504-903-3000
Practice Address - Fax:504-903-3580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1799998Medicaid
LA5CH27Medicare ID - Type UnspecifiedCRNA ONLY