# PEDIATRIC SURGERY OF LOUISIANA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548309156
- **Authorized official:** FAITH HANSBROUGH MD (PHYSICIAN)
- **Authorized official phone:** (225) 769-2295

## Contact information

- **Practice address:** 7777 HENNESSY BLVD, SUITE 212, BATON ROUGE, LA 70808
- **Practice address phone:** (225) 769-2295
- **Practice address fax:** (225) 769-2297
- **Mailing address:** 7777 HENNESSY BLVD, SUITE 212, BATON ROUGE, LA 70808
- **Mailing address phone:** (225) 769-2295
- **Mailing address fax:** (225) 769-2297

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0120X | Pediatric Surgery Physician | — | NULL | Yes |
| 2086S0120X | Pediatric Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/06/2007
- **Last updated:** 01/16/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1442534 | — | LA |