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NPI Code Detail

MEDICARE: BROUSSARD SURGERY INSTITUTE, INC.

MEDICARE: BROUSSARD SURGERY INSTITUTE, 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
1261QS0132XOphthalmologic Surgery Clinic/Center124LA

Other Identifiers

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

General Provider Information

NPI Number : 1649215765
Entity Type Code : Organization
Provider Name (Legal Business Name) : BROUSSARD SURGERY INSTITUTE, INC.
Provider Business Mailing Address
First Line : 1250 PECANLAND RD
Second Line : SUITE E-1
City : MONROE
State : LA
Zip : 71203-7011
Country : US
Telephone Number : 318-387-2015
Fax Number : 318-387-2097
Provider Business Practice Location Address
First Line : 1250 PECANLAND RD
Second Line : SUITE E-1
City : MONROE
State : LA
Zip : 71203-7011
Country : US
Telephone Number : 318-387-2015
Fax Number : 318-387-2097
Authorized Official
Title or Position : BUSINESS MANAGER
Name : DANICA G NELSON
Credential :
Telephone Number : 318-387-2015
Provider Enumeration Date : 06/20/2006
Last Update Date : 08/22/2020

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