Healthcare Provider Details

I. General information

NPI: 1194838052
Provider Name (Legal Business Name): BATON ROUGE GENERAL PHYSICIANS HOSPITAL SPECIALISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 FLORIDA BLVD
BATON ROUGE LA
70809
US

IV. Provider business mailing address

PO BOX 4869 DEPT: 235
HOUSTON TX
77210-4869
US

V. Phone/Fax

Practice location:
  • Phone: 225-387-7724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KENDALL JOHNSON
Title or Position: C.F.O.
Credential:
Phone: 225-237-1645