Provider Demographics
NPI:1992477111
Name:HOSPITAL SERVICE DISTRICT 1 OF EAST BATON ROUGE PARISH
Entity type:Organization
Organization Name:HOSPITAL SERVICE DISTRICT 1 OF EAST BATON ROUGE PARISH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-658-4303
Mailing Address - Street 1:6300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-4037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4801 MCHUGH RD STE C
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-5364
Practice Address - Country:US
Practice Address - Phone:225-658-4065
Practice Address - Fax:225-570-2986
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL SERVICE DISTRICT 1 OF EAST BATON ROUGE PARISH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty