Healthcare Provider Details

I. General information

NPI: 1962089789
Provider Name (Legal Business Name): LSU AMBULATORY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FLORIDA AVE 2ND FLOOR SUITE 2554
NEW ORLEANS LA
70119-2743
US

IV. Provider business mailing address

1100 FLORIDA AVE 2ND FLOOR SUITE 2554
NEW ORLEANS LA
70119-2743
US

V. Phone/Fax

Practice location:
  • Phone: 504-941-8820
  • Fax: 504-941-8821
Mailing address:
  • Phone: 504-941-8820
  • Fax: 504-941-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT LAUGHLIN
Title or Position: DEAN - LSU SCHOOL OF DENTISTRY
Credential: DMD
Phone: 504-889-9893