Basic Information
| Provider Information | |||||||||
| NPI: | 1275984973 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS FACULTY | ||||||||
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| OtherOrganizationName: | LSU ED BILLING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1542 TULANE AVE | ||||||||
| Address2: | STE 123-HCN | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701122865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044121819 | ||||||||
| FaxNumber: | 5044121954 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 CANAL ST | ||||||||
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| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701123018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5047023000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2016 | ||||||||
| LastUpdateDate: | 12/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | MCAVOY | ||||||||
| AuthorizedOfficialFirstName: | ATARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 5044121819 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.