1881717577 NPI number — BATON ROUGE ORTHOPAEDIC CLINIC

Table of content: (NPI 1881717577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881717577 NPI number — BATON ROUGE ORTHOPAEDIC CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BATON ROUGE ORTHOPAEDIC CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881717577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3642 ALLENE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRUSLY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70719-2085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-749-7660
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8080 BLUEBONNET BLVD
Provider Second Line Business Practice Location Address:
1000
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70810-7827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-924-2424
Provider Business Practice Location Address Fax Number:
225-408-7929
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ST. CYR
Authorized Official First Name:
ANNE
Authorized Official Middle Name:
SCHUPBACH
Authorized Official Title or Position:
RADIOLOGIC TECHNOLOGIST
Authorized Official Telephone Number:
225-924-2424

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  7009 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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