Healthcare Provider Details

I. General information

NPI: 1528606084
Provider Name (Legal Business Name): SUPERIOR SURGICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14141 AZALEA PARK AVE APT C
BATON ROUGE LA
70816-1674
US

IV. Provider business mailing address

14141 AZALEA PARK AVE APT C
BATON ROUGE LA
70816-1674
US

V. Phone/Fax

Practice location:
  • Phone: 573-410-2908
  • Fax:
Mailing address:
  • Phone: 573-410-2908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: KAREN LYNN BASHAM
Title or Position: MANAGING PARTNER
Credential: CSFA
Phone: 573-410-2908