MEDICARE: LSU MEDICAL CENTER

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TC2200X	Clinical Child & Adolescent Psychologist
2	225100000X	Physical Therapist
3	225C00000X	Rehabilitation Counselor
4	225X00000X	Occupational Therapist
5	231H00000X	Audiologist
6	235Z00000X	Speech-Language Pathologist

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1588737803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LSU MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 62600
Second Line	:	DEPARTMENT 1268
City	:	NEW ORLEANS
State	:	LA
Zip	:	70162-2600
Country	:	US
Telephone Number	:	504-568-4250
Fax Number	:	504-568-4249

Provider Business Practice Location Address
First Line	:	1900 GRAVIER ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-2262
Country	:	US
Telephone Number	:	504-568-4250
Fax Number	:	504-568-4249

Authorized Official
Title or Position	:	ASSISTANT TO THE DEAN
Name	:	MS. ELIZABETH GOUAUX LEVITZKY
Credential	:
Telephone Number	:	504-568-4250

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	12/07/2011

1900 GRAVIER ST
NEW ORLEANS, LA
70112-2262

Practice Phone: 504-568-4221
Practice Fax:

1900 GRAVIER ST , 6TH FLOOR
NEW ORLEANS, LA
70112-2262