Healthcare Provider Details

I. General information

NPI: 1881078764
Provider Name (Legal Business Name): LSU HSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 BOLIVAR ST
NEW ORLEANS LA
70112-7021
US

IV. Provider business mailing address

433 BOLIVAR ST
NEW ORLEANS LA
70112-7021
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-4808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. ERICH CONRAD
Title or Position: PROGRAM DIRECTOR
Credential: M.D.
Phone: 504-412-1580