Healthcare Provider Details

I. General information

NPI: 1740061076
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: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 MAIN ST STE C
ZACHARY LA
70791-4079
US

IV. Provider business mailing address

6300 MAIN ST
ZACHARY LA
70791-4037
US

V. Phone/Fax

Practice location:
  • Phone: 225-658-4303
  • Fax: 225-658-4287
Mailing address:
  • Phone: 225-658-4303
  • Fax: 225-658-4287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

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