Healthcare Provider Details

I. General information

NPI: 1588737803
Provider Name (Legal Business Name): LSU MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 GRAVIER ST
NEW ORLEANS LA
70112-2262
US

IV. Provider business mailing address

PO BOX 62600 DEPARTMENT 1268
NEW ORLEANS LA
70162-2600
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-4250
  • Fax: 504-568-4249
Mailing address:
  • Phone: 504-568-4250
  • Fax: 504-568-4249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. ELIZABETH GOUAUX LEVITZKY
Title or Position: ASSISTANT TO THE DEAN
Credential:
Phone: 504-568-4250