Healthcare Provider Details

I. General information

NPI: 1033425012
Provider Name (Legal Business Name): LOUISIANA CENTER FOR ORTHOPAEDIC & SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7414 PICARDY AVE SUITE A
BATON ROUGE LA
70808-4696
US

IV. Provider business mailing address

7414 PICARDY AVE SUITE A
BATON ROUGE LA
70808-4696
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-6595
  • Fax: 225-769-5064
Mailing address:
  • Phone: 225-769-6595
  • Fax: 225-769-5064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: BECKY CROXTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 225-769-6595