Healthcare Provider Details

I. General information

NPI: 1639944580
Provider Name (Legal Business Name): ORTHOPEDIC AND SPORTS MEDICINE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 BLUEBONNET BLVD STE 1000
BATON ROUGE LA
70810-7827
US

IV. Provider business mailing address

8080 BLUEBONNET BLVD STE 1000
BATON ROUGE LA
70810-7827
US

V. Phone/Fax

Practice location:
  • Phone: 225-924-2424
  • Fax:
Mailing address:
  • Phone: 225-924-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL WILLIAMSON
Title or Position: CEO
Credential:
Phone: 225-924-2424