Healthcare Provider Details

I. General information

NPI: 1619982378
Provider Name (Legal Business Name): SOUTHEAST LOUISIANA VETERANS HEALTH CARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7968 ESSEN PARK
BATON ROUGE LA
70809-7439
US

IV. Provider business mailing address

10348 MARANATHA ACRES
SAINT AMANT LA
70774-4425
US

V. Phone/Fax

Practice location:
  • Phone: 225-761-6700
  • Fax:
Mailing address:
  • Phone: 225-761-6792
  • Fax: 225-761-6070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberAP03606
License Number StateLA

VIII. Authorized Official

Name: DR. JAMIE BUTH
Title or Position: ASSOCIATE CHIEF OF STAFF CLINICS
Credential: MD
Phone: 504-568-0811