MEDICARE: BATON ROUGE GENERAL 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	207Q00000X	Family Medicine Physician	MD019597	LA

General Provider Information

NPI Number	:	1407284540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BATON ROUGE GENERAL MEDICAL CENTER

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

Provider Business Practice Location Address
First Line	:	610 N JEFFERSON AVE
Second Line	:
City	:	PORT ALLEN
State	:	LA
Zip	:	70767-2414
Country	:	US
Telephone Number	:	225-267-6626
Fax Number	:	225-267-5993

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

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	12/26/2018

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