1902671076 NPI number — LOUISIANA FOOT AND ANKLE SPECIALTY CENTER, 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 1902671076 NPI number — LOUISIANA FOOT AND ANKLE SPECIALTY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUISIANA FOOT AND ANKLE SPECIALTY CENTER, 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:
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:
1902671076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1239 PATRIOT XING
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZACHARY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70791-7835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-513-7155
Provider Business Mailing Address Fax Number:
225-250-1407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1169 HIGHWAY 19 STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLAUGHTER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70777-3404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-615-1656
Provider Business Practice Location Address Fax Number:
225-659-8031
Provider Enumeration Date:
11/20/2023

Additional Information

Authorized Official

Authorized Official Last Name:
LINDOW
Authorized Official First Name:
KYLE
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
504-615-1656

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com