Healthcare Provider Details

I. General information

NPI: 1912199670
Provider Name (Legal Business Name): LSUHSC MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 GRAVIER ST
NEW ORLEANS LA
70112-2272
US

IV. Provider business mailing address

3101 CLEARY AVE APT # 11
METAIRIE LA
70002-7308
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-3792
  • Fax:
Mailing address:
  • Phone: 504-261-1789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberGETP.LSU.IM
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License NumberGETP.LSU.IM
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberGETP.LSU.IM
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberGETP.LSU.IM
License Number StateLA

VIII. Authorized Official

Name: JORGE MARTINEZ
Title or Position: PROGRAM DIRECTOR
Credential: M.D
Phone: 504-568-3930