Healthcare Provider Details

I. General information

NPI: 1144377102
Provider Name (Legal Business Name): BATON ROUGE CARDIOLOGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5231 BRITTANY DR
BATON ROUGE LA
70808-9100
US

IV. Provider business mailing address

5231 BRITTANY DR
BATON ROUGE LA
70808-9100
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-0933
  • Fax: 225-769-6255
Mailing address:
  • Phone: 225-769-0933
  • Fax: 225-769-6255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH WALKER
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 225-769-0933