Provider Demographics
NPI:1548309156
Name:PEDIATRIC SURGERY OF LOUISIANA, LLC
Entity type:Organization
Organization Name:PEDIATRIC SURGERY OF LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-769-2295
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808
Mailing Address - Country:US
Mailing Address - Phone:225-769-2295
Mailing Address - Fax:225-769-2297
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-769-2295
Practice Address - Fax:225-769-2297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1442534Medicaid
LA1442534Medicaid
LA1367486Medicaid