Provider Demographics
NPI:1922815240
Name:LOUISIANA STAT CARE LLC
Entity type:Organization
Organization Name:LOUISIANA STAT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-909-0193
Mailing Address - Street 1:11055 SHOE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-4022
Mailing Address - Country:US
Mailing Address - Phone:225-261-4493
Mailing Address - Fax:866-657-2791
Practice Address - Street 1:11055 SHOE CREEK DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-4022
Practice Address - Country:US
Practice Address - Phone:225-261-4493
Practice Address - Fax:866-657-2791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty