MEDICARE: PROMISE HOSPITAL OF BATON ROUGE INC

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	282E00000X	Long Term Care Hospital	517	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60656	OTHER	LA	BLUE CROSS PROVIDER

General Provider Information

NPI Number	:	1275595597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMISE HOSPITAL OF BATON ROUGE INC

Provider Business Mailing Address
First Line	:	999 YAMATO ROAD
Second Line	:	3RD FLOOR
City	:	BOCA RATON
State	:	FL
Zip	:	33431
Country	:	US
Telephone Number	:	561-869-3100
Fax Number	:	561-826-0171

Provider Business Practice Location Address
First Line	:	3600 FLORIDA BLVD FL 4
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3842
Country	:	US
Telephone Number	:	225-387-7770
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JAMES HOPWOOD
Credential	:
Telephone Number	:	561-869-3100

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	03/17/2018

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