Healthcare Provider Details

I. General information

NPI: 1700048899
Provider Name (Legal Business Name): LSU-HSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 PERDIDO ST
NEW ORLEANS LA
70112-1393
US

IV. Provider business mailing address

1901 PERDIDO ST
NEW ORLEANS LA
70112-1393
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-7006
  • Fax: 504-568-6037
Mailing address:
  • Phone: 504-568-7006
  • Fax: 504-568-6037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberMD.202124
License Number StateLA

VIII. Authorized Official

Name: DR. GARY LIPSCOMB
Title or Position: PROGRAM DIRECTOR
Credential: M.D.
Phone: 504-568-7002