Healthcare Provider Details

I. General information

NPI: 1003075441
Provider Name (Legal Business Name): WOMENS PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 BLUEBONNET BLVD
BATON ROUGE LA
70809-3076
US

IV. Provider business mailing address

5145 BLUEBONNET BLVD
BATON ROUGE LA
70809-3076
US

V. Phone/Fax

Practice location:
  • Phone: 225-408-1422
  • Fax: 225-408-1462
Mailing address:
  • Phone: 225-408-1422
  • Fax: 225-408-1462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1192
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11665
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number021832
License Number StateLA

VIII. Authorized Official

Name: DR. JAMES G GENGELBACH
Title or Position: OWNER
Credential: D.O.
Phone: 225-408-1422