Basic Information
| Provider Information | |||||||||
| NPI: | 1982650206 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LAKEVIEW MEDICAL CENTER, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LAKEVIEW REGIONAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 JUDGE TANNER BLVD | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704337500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858673800 | ||||||||
| FaxNumber: | 9858674449 | ||||||||
| Practice Location | |||||||||
| Address1: | 195 HIGHLAND PARK ENTRANCE | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704337164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858673800 | ||||||||
| FaxNumber: | 9858674449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 04/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | BRESLIN | ||||||||
| AuthorizedOfficialFirstName: | TIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9858674446 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LAKEVIEW MEDICAL CENTER, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | Y | Hospital Units | Psychiatric Unit |
No ID Information.