Provider Demographics
NPI:1104857671
Name:LIFEMARK HOSPITALS OF LOUISIANA, INC.
Entity type:Organization
Organization Name:LIFEMARK HOSPITALS OF LOUISIANA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF TAXATION, TENET HEALTHCARE
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:RABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2530
Mailing Address - Street 1:PO BOX 676733
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-6733
Mailing Address - Country:US
Mailing Address - Phone:214-387-6444
Mailing Address - Fax:504-464-8062
Practice Address - Street 1:180 W ESPLANADE AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2467
Practice Address - Country:US
Practice Address - Phone:504-468-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA300282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
60779OtherBCBS OF LOUISIANA
LA1744611Medicaid
LA1705551Medicaid
000449OtherHUMANA
LA1744701Medicaid
190206B000000OtherSECTION 1011
33721OtherBCBS OF LOUISIANA
84889OtherCOVENTRY HEALTH CARE LOUI
LA1744701Medicaid