Healthcare Provider Details

I. General information

NPI: 1730410408
Provider Name (Legal Business Name): VASCULAR SPECIALTY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8888 SUMMA AVE FL 3
BATON ROUGE LA
70809-3720
US

IV. Provider business mailing address

8888 SUMMA AVE FL 3
BATON ROUGE LA
70809-3720
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-4493
  • Fax: 225-766-3144
Mailing address:
  • Phone: 225-769-4493
  • Fax: 225-766-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. NAOMI D NELSON
Title or Position: COO
Credential: MHA
Phone: 225-769-4493