Healthcare Provider Details

I. General information

NPI: 1225382187
Provider Name (Legal Business Name): INTERVENTIONAL PAIN INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8017 PICARDY AVE
BATON ROUGE LA
70809-3538
US

IV. Provider business mailing address

8017 PICARDY AVE
BATON ROUGE LA
70809-3538
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-3636
  • Fax: 225-771-8047
Mailing address:
  • Phone: 225-769-3636
  • Fax: 225-771-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number204474
License Number StateLA

VIII. Authorized Official

Name: BARRETT A. JOHNSTON
Title or Position: PHYSICIAN
Credential: MD
Phone: 225-769-3636