Healthcare Provider Details

I. General information

NPI: 1417135237
Provider Name (Legal Business Name): LSU MEDICAL CENTER CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 GRAVIER ST ROOM 6B21
NEW ORLEANS LA
70112-2262
US

IV. Provider business mailing address

1900 GRAVIER ST ROOM 6B21
NEW ORLEANS LA
70112-2262
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 TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

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