Healthcare Provider Details

I. General information

NPI: 1366483315
Provider Name (Legal Business Name): WOMAN'S SPECIALTY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RUE DE LA VIE ST SUITE 515
BATON ROUGE LA
70817-5127
US

IV. Provider business mailing address

500 RUE DE LA VIE ST STE 311
BATON ROUGE LA
70817-5128
US

V. Phone/Fax

Practice location:
  • Phone: 225-924-8550
  • Fax: 225-924-8647
Mailing address:
  • Phone: 225-924-8550
  • Fax: 225-924-8647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERI G FONTENOT
Title or Position: CEO AND PRESIDENT
Credential:
Phone: 225-927-1300