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Organization
OAC LLC
Active
Organization
OAC LLC
Active
Other names
Vital Source Specialty Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JULIE ALLEN-TULLIER (BUSINESS OFFICE DIRECTOR VITALSOURC)
(225) 766-5001
Entity
Organization
Contact information
Practice address
5130 MANCUSO LANE, BATON ROUGE, LA 70809-3583
(225) 766-5001
(225) 766-5001
Mailing address
5130 MANCUSO LANE, BATON ROUGE, LA 70809-3583
(225) 766-5001
(225) 766-5001
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190061363Z
BLUE CROSS OF LA
LA
Enumeration date
03/17/2006
Last updated
01/12/2009
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