MEDICARE: LOUISIANA STATE UNIVERSITY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	133V00000X	Registered Dietitian
3	261Q00000X	Clinic/Center
4	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

General Provider Information

NPI Number	:	1922566934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISIANA STATE UNIVERSITY

Provider Business Mailing Address
First Line	:	6400 PERKINS RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-0102
Country	:	US
Telephone Number	:	225-763-3101
Fax Number	:	225-763-3102

Provider Business Practice Location Address
First Line	:	6400 PERKINS RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-0102
Country	:	US
Telephone Number	:	225-763-3101
Fax Number	:	225-763-3102

Authorized Official
Title or Position	:	CFO/COO
Name	:	GUY JOEL LAVERGNE
Credential	:
Telephone Number	:	225-763-3101

Provider Enumeration Date	:	03/08/2019
Last Update Date	:	06/06/2025

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Directions to “LOUISIANA STATE UNIVERSITY ” Practice Location

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