MEDICARE: LAKE SURGICAL HOSPITAL SLIDELL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1396520862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE SURGICAL HOSPITAL SLIDELL, LLC

Provider Business Mailing Address
First Line	:	1700 LINDBERG DR
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70458-8062
Country	:	US
Telephone Number	:	985-641-0600
Fax Number	:	844-269-8002

Provider Business Practice Location Address
First Line	:	1810 LINDBERG DR STE 1400
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70458-8158
Country	:	US
Telephone Number	:	985-641-0600
Fax Number	:	844-269-8002

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL PISCIOTTA
Credential	:
Telephone Number	:	985-641-0600

Provider Enumeration Date	:	08/31/2023
Last Update Date	:	09/26/2023

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