Basic Information
| Provider Information | |||||||||
| NPI: | 1447417225 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LSUHN BILLING LLC | ||||||||
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| OtherOrganizationName: | LSU MOBILE HEALTH UNIT | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 62600 | ||||||||
| Address2: | DEPT 1432 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701622600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8779881890 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5825 AIRLINE HWY | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708052408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8779881890 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2008 | ||||||||
| LastUpdateDate: | 05/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | SELLERS | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3377061533 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1017817 | 05 | LA | MEDICAID |