Healthcare Provider Details

I. General information

NPI: 1134130222
Provider Name (Legal Business Name): LSA, A PMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5253 DIJON DR SUITE A
BATON ROUGE LA
70808-4312
US

IV. Provider business mailing address

5253 DIJON DR SUITE A
BATON ROUGE LA
70808-4312
US

V. Phone/Fax

Practice location:
  • Phone: 225-768-1611
  • Fax: 225-768-1615
Mailing address:
  • Phone: 225-768-1611
  • Fax: 225-768-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUDITH RADOSTI
Title or Position: OFFICE MANAGER
Credential:
Phone: 225-768-1611