Basic Information
| Provider Information | |||||||||
| NPI: | 1386734762 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY HEALTHCARE SYSTEMS, LC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TULANE UNIVERSITY HOSPITAL & CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 E FAIRWAY DR | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | COVINGTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704337500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049885800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 95 E FAIRWAY DR | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | COVINGTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704337500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049885800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 10/11/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LAGEESE | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5049887044 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COLUMBIA/HCA OF NEW ORLEANS, INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | LA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1944386 | 05 | LA | MEDICAID |