Basic Information
Provider Information
NPI: 1336103001
EntityType: 2
ReplacementNPI:  
OrganizationName: PERKINS PLAZA AMBULATORY SURGERY CENTER LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: LAKE SURGERY CENTER
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7145 PERKINS RD
Address2:  
City: BATON ROUGE
State: LA
PostalCode: 708084322
CountryCode: US
TelephoneNumber: 2257653111
FaxNumber: 2257653114
Practice Location
Address1: 7145 PERKINS RD
Address2:  
City: BATON ROUGE
State: LA
PostalCode: 708084322
CountryCode: US
TelephoneNumber: 2257653111
FaxNumber: 2257653114
Other Information
ProviderEnumerationDate: 04/12/2006
LastUpdateDate: 01/18/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: HEINE
AuthorizedOfficialFirstName: ANN
AuthorizedOfficialMiddleName: L.
AuthorizedOfficialTitleorPosition: ADMINISTRATOR
AuthorizedOfficialTelephone: 2254085548
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MRS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QA1903X116LAY Ambulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical

ID Information
IDTypeStateIssuerDescription
115223405MS MEDICAID
115223405LA MEDICAID


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