Provider Demographics
NPI:1962089789
Name:LSU AMBULATORY SURGERY CENTER
Entity type:Organization
Organization Name:LSU AMBULATORY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEAN - LSU SCHOOL OF DENTISTRY
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:504-889-9893
Mailing Address - Street 1:1100 FLORIDA AVE 2ND FLOOR
Mailing Address - Street 2:SUITE 2554
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-2743
Mailing Address - Country:US
Mailing Address - Phone:504-941-8820
Mailing Address - Fax:504-941-8821
Practice Address - Street 1:1100 FLORIDA AVE 2ND FLOOR
Practice Address - Street 2:SUITE 2554
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-2743
Practice Address - Country:US
Practice Address - Phone:504-941-8820
Practice Address - Fax:504-941-8821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty