Healthcare Provider Details

I. General information

NPI: 1265702237
Provider Name (Legal Business Name): LSUHSC NEW ORLEANS PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 KERLEREC ST
NEW ORLEANS LA
70116-1819
US

IV. Provider business mailing address

433 BOLIVAR ST
NEW ORLEANS LA
70112-7021
US

V. Phone/Fax

Practice location:
  • Phone: 504-947-3065
  • Fax: 504-945-4968
Mailing address:
  • Phone: 504-359-1120
  • Fax: 504-861-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number202226
License Number StateLA

VIII. Authorized Official

Name: LEONE COE
Title or Position: ASSISTANT BUSINESS MANAGER
Credential:
Phone: 504-896-2798