Provider Demographics
NPI:1447250667
Name:CENTRAL LOUISIANA AMBULATORY SURGICAL CENTER
Entity type:Organization
Organization Name:CENTRAL LOUISIANA AMBULATORY SURGICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:318-443-3511
Mailing Address - Street 1:651 N BOLTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-7449
Mailing Address - Country:US
Mailing Address - Phone:318-443-3511
Mailing Address - Fax:318-443-5260
Practice Address - Street 1:651 N BOLTON AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-7449
Practice Address - Country:US
Practice Address - Phone:318-443-3511
Practice Address - Fax:318-443-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA138261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1347213Medicaid
LA1347213Medicaid