Healthcare Provider Details

I. General information

NPI: 1679818892
Provider Name (Legal Business Name): CENTER FOR INNOVATIONS IN EVALUATIVE MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9373 BARINGER FOREMAN RD, BLDG 2
BATON ROUGE LA
70817-6200
US

IV. Provider business mailing address

9373 BARINGER FOREMAN RD, BLDG 2
BATON ROUGE LA
70817-6200
US

V. Phone/Fax

Practice location:
  • Phone: 225-754-8888
  • Fax: 225-755-2147
Mailing address:
  • Phone: 225-754-8888
  • Fax: 225-755-2147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number24539
License Number StateLA

VIII. Authorized Official

Name: MELINDA NOEL
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 225-754-8888