Healthcare Provider Details

I. General information

NPI: 1326249459
Provider Name (Legal Business Name): HOSPITAL SERVICE DISTRICT 1 OF EAST BATON ROUGE PARISH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4917 WEST PARK DRIVE
ZACHARY LA
70791-4069
US

IV. Provider business mailing address

4917 WEST PARK DRIVE
ZACHARY LA
70791-4069
US

V. Phone/Fax

Practice location:
  • Phone: 225-658-4110
  • Fax: 225-658-4108
Mailing address:
  • Phone: 225-658-4110
  • Fax: 225-658-4108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number StateLA

VIII. Authorized Official

Name: LARRY R MEESE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 225-658-4303