Healthcare Provider Details

I. General information

NPI: 1134354202
Provider Name (Legal Business Name): ST. CHARLES SURGICAL HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 SAINT CHARLES AVE
NEW ORLEANS LA
70130-5223
US

IV. Provider business mailing address

1717 SAINT CHARLES AVE
NEW ORLEANS LA
70130-5223
US

V. Phone/Fax

Practice location:
  • Phone: 504-899-2800
  • Fax: 504-899-2700
Mailing address:
  • Phone: 504-899-2800
  • Fax: 504-899-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MYRA DIGANGE
Title or Position: ADMINISTRATOR
Credential: R.N.
Phone: 504-899-2800