MEDICARE: ENT MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225028038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENT MEDICAL CENTER

Provider Business Mailing Address
First Line	:	5258 DIJON DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4311
Country	:	US
Telephone Number	:	225-769-1090
Fax Number	:	225-769-4812

Provider Business Practice Location Address
First Line	:	5258 DIJON DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4311
Country	:	US
Telephone Number	:	225-769-1090
Fax Number	:	225-769-4812

Authorized Official
Title or Position	:	SENIOR PARTNER
Name	:	DR. CHARLES F MITCHELL
Credential	:	M.D.
Telephone Number	:	225-769-1090

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	08/22/2020

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1902891476 — DR. RYAN T BOONE M.D.
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70808-4311

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1609861871 — DR. CHARLES F MITCHELL II M.D.
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Practice Fax: 225-769-4812

Directions to “ENT MEDICAL CENTER ” Practice Location

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