Provider Demographics
NPI:1285253252
Name:OCHSNER LSU HEALTH SHREVEPORT - ST. MARY MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:OCHSNER LSU HEALTH SHREVEPORT - ST. MARY MEDICAL CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MITZI
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-626-0050
Mailing Address - Street 1:1512 W KIRBY PL
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3822
Mailing Address - Country:US
Mailing Address - Phone:318-626-0287
Mailing Address - Fax:318-629-4833
Practice Address - Street 1:911 MARGARET PL
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4347
Practice Address - Country:US
Practice Address - Phone:318-626-4300
Practice Address - Fax:318-399-7683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NW0100XHospitalsGeneral Acute Care HospitalWomen
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No282NC2000XHospitalsGeneral Acute Care HospitalChildren