Provider Demographics
NPI:1750617924
Name:LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN
Entity type:Organization
Organization Name:LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ATARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCAVOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-412-1819
Mailing Address - Street 1:478 S JOHNSON ST FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3601 HOUMA BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4326
Practice Address - Country:US
Practice Address - Phone:504-412-1600
Practice Address - Fax:504-780-8922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1293240001Medicare NSC