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OLOL PONTCHARTRAIN SURGERY CENTER LLC NPI 1497090740


NPI Information

NPI: 1497090740
Provider Name: OLOL PONTCHARTRAIN SURGERY CENTER, LLC

Doing Business As: OUR LADY OF THE LAKE PONTCHARTRAIN SURGERY CENTER

Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 19D1081119

Address:
4407 HIGHWAY 190 EAST SERVICE RD
STE 200
COVINGTON, LA
ZIP 70433
Phone: (985) 234-9700
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OLOL PONTCHARTRAIN SURGERY CENTER, LLC is an ambulatory surgical clinic center in Covington, LA. OLOL PONTCHARTRAIN SURGERY CENTER, LLC NPI is 1497090740. The provider is registered as an organization entity type.
The provider Is Doing Business As Our Lady Of The Lake Pontchartrain Surgery Center.

The provider's business location address is:

4407 HIGHWAY 190 EAST SERVICE RD
STE 200
COVINGTON, LA
ZIP 70433-957
Phone: (985) 234-9700
Fax: (985) 234-9706

The provider's authorized official is Jenetha D Moran .
The authorized official title is Authorized Official and has the following contact phone number (972) 763-3893.

The CLIA number assigned to this NPI record is 19D1081119 - ambulance with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/27/2012 and was last updated on 9/6/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QA1903XClinic/CenterAmbulatory Surgical157LOUISIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1290889MEDICARE PINLOUISIANA
219C0001113MEDICARE OSCAR/CERTIFICATIONLOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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