Provider Demographics
NPI:1437108297
Name:LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS FACULTY G
Entity type:Organization
Organization Name:LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS FACULTY G
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ATARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCAVOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-412-1819
Mailing Address - Street 1:478 S JOHNSON ST FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:180 W ESPLANADE AVE
Practice Address - Street 2:ANESTHESIA DEPT.
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2467
Practice Address - Country:US
Practice Address - Phone:504-468-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07322221Medicaid
LA1447871Medicaid
MS05252078Medicaid
LA5CT29Medicare PIN
LADE5359Medicare PIN
LA1447871Medicaid
MS07322221Medicaid