Provider Demographics
NPI:1649327107
Name:LSAHSC EARL K. LONG MEDICAL CENTER
Entity type:Organization
Organization Name:LSAHSC EARL K. LONG MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EKL MEDICAL STAFF DEPT. MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:225-354-2051
Mailing Address - Street 1:17010 ABITA AVENUE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769
Mailing Address - Country:US
Mailing Address - Phone:225-266-5177
Mailing Address - Fax:
Practice Address - Street 1:1401 N FOSTER DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1818
Practice Address - Country:US
Practice Address - Phone:225-987-9013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPM.PD0105261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health