Hospital Service District 1 of East Baton Rouge Parish
Organization Active NPI Undersea and Hyperbaric Medicine (Preventive Medicine) Physician · Zachary, LA
NPI 1326249459 · NPPES record last updated Feb 14, 2018
Key facts
- NPI
- 1326249459
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Undersea and Hyperbaric Medicine (Preventive Medicine) Physician 2083P0011X
- Legal business name
- HOSPITAL SERVICE DISTRICT 1 OF EAST BATON ROUGE PARISH
- Practice address
- 4917 West Park Drive
Zachary, LA 70791-4069 - Phone
- (225) 658-4110
- Fax
- (225) 658-4108
- NPI assigned
- May 29, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- HOSPITAL SERVICE DISTRICT 1 OF
Authorized official
- Name
- Larry R Meese
- Title
- Chief Executive Officer
- Phone
- (225) 658-4303
Other NPIs on the same Medicare enrollment 14
Corporate family (same tax ID) 20
Practitioners 35
-
Dainelle Renee Gordon Story, MSN, APRN, FNP-C
-
Thomas N Trahan, MD
-
Joshua Best, M.D.
-
Fredrick James Bohanon, M.D.
-
Michelle F Cosse, MD
-
Allison Cross, P.A.
-
Keith Brian Elbourne, M.D.
-
Jeanne Nicole Gautreaux, M.D.
-
Thomas Jeffrey Gould, M.D.
-
Maranath N Graugnard, FNP-BC
-
Thomas Charles Laborde, M.D.
-
Gia Tyson Landry, M.D.
-
Jessica Leblanc, MD
-
Kelly Magill Pilcher, FNP-C
-
Ashley Coreil Record, M.D.
-
Bikal Sapkota, M.D
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040322000429 | LA | Part B Supplier - Clinic/Group Practice | 0941191902 |
Receives reassigned benefits from 76 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Zachary, LA |
National Provider Directory
- Tax ID family
- Wayne D Gravois
- Part of
- Wayne D Gravois
Locations
6550 Main St
Ste 2000
Zachary, LA 70791
Phone (225) 235-9308
6550 Main St
Ste 2300
Zachary, LA 70791
Phone (225) 658-1808
4801 McHugh Rd
Zachary, LA 70791
19900 Old Scenic Hwy
Ste Hi
Zachary, LA 70791
Phone (225) 570-2618
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Wound Care Registered Nurse |
163WW0000X | LA | ||
| Undersea and Hyperbaric Medicine (Emergency Medicine) Physician |
207PE0005X | |||
| Undersea and Hyperbaric Medicine (Preventive Medicine) Physician |
2083P0011X | LA | Yes |
Addresses
Primary practice location
4917 West Park Drive
Zachary, LA 70791-4069
Mailing address
4917 West Park Drive
Zachary, LA 70791-4069
Phone (225) 658-4110
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1796662 | Medicaid | LA |
Other names
- LANE REGIONAL MEDICAL CENTER-LANE WOUND CENTER
Other providers in Zachary, LA
- Hospital Service District #1 of East Baton Rouge Parish
- Hospital Service District #1 of East Baton Rouge Parish
- Hospital Service District 1 of East Baton Rouge Parish
- Hospital Service District 1 of East Baton Rouge Parish
- Hospital Service District 1 of East Baton Rouge Parish
- Hospital Service District 1 of East Baton Rouge Parish
- Hospital Service District 1 of East Baton Rouge Parish
- Hospital Service District 1 of East Baton Rouge Parish
- Hospital Service District 1 of East Baton Rouge Parish
- Hospital Service District 1 of East Baton Rouge Parish
All providers in Zachary, LA · Undersea and Hyperbaric Medicine (Preventive Medicine) Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.