Healthcare Provider Details

I. General information

NPI: 1609880590
Provider Name (Legal Business Name): SCOTT PAVUR ATC, LAT, NREMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 LAVEY LN SUITE 96
BAKER LA
70714-4280
US

IV. Provider business mailing address

5885 LAVEY LN LOT 96
BAKER LA
70714-4280
US

V. Phone/Fax

Practice location:
  • Phone: 225-615-7530
  • Fax: 225-615-7530
Mailing address:
  • Phone: 225-615-7530
  • Fax: 225-615-7530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberB0467966
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberJ00010
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: