1669760948 NPI number — BATON ROUGE GENERAL PRIMARY CARE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669760948 NPI number — BATON ROUGE GENERAL PRIMARY CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BATON ROUGE GENERAL PRIMARY CARE, LLC
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:
6
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:
1669760948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8490 PICARDY AVE
Provider Second Line Business Mailing Address:
BLDG 200
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70809-3731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-237-1754
Provider Business Mailing Address Fax Number:
225-237-1722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8585 PICARDY AVE
Provider Second Line Business Practice Location Address:
SUITE 513
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809-3679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-819-1198
Provider Business Practice Location Address Fax Number:
225-819-1189
Provider Enumeration Date:
07/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
KENDALL
Authorized Official Middle Name:
Authorized Official Title or Position:
C.F.O.
Authorized Official Telephone Number:
225-237-1645

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5DV54 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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