Provider Demographics
NPI:1154904233
Name:LOYOLA UNIVERSITY NEW ORLEANS STUDENT HEALTH CENTER
Entity type:Organization
Organization Name:LOYOLA UNIVERSITY NEW ORLEANS STUDENT HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-616-9710
Mailing Address - Street 1:6363 SAINT CHARLES AVE # 200
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-6195
Mailing Address - Country:US
Mailing Address - Phone:504-616-9710
Mailing Address - Fax:504-865-2382
Practice Address - Street 1:6363 SAINT CHARLES AVE # 200
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-6195
Practice Address - Country:US
Practice Address - Phone:504-616-9710
Practice Address - Fax:504-865-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty