# SOUTHEASTERN LOUISIANA UNIVERISITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SLU Sports Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780075499
- **Authorized official:** JOHN IRWIN (ASST. DIRECTOR FOR SPORTS MEDICINE)
- **Authorized official phone:** (985) 549-5133

## Contact information

- **Practice address:** 800 GALLOWAY DR, DUGAS CENTER, HAMMOND, LA 70402-0001
- **Practice address phone:** (985) 549-5133
- **Practice address fax:** (972) 367-3451
- **Mailing address:** PO BOX 650850, DEPT. 1011, DALLAS, TX 75265-0850
- **Mailing address phone:** (800) 555-9073
- **Mailing address fax:** (972) 367-3452

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/17/2015
- **Last updated:** 02/17/2015