Healthcare Provider Details

I. General information

NPI: 1750523429
Provider Name (Legal Business Name): BATON ROUGE AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 03/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 BLUEBONNET BLVD SUITE 2222
BATON ROUGE LA
70810-7827
US

IV. Provider business mailing address

8080 BLUEBONNET BLVD SUITE 2222
BATON ROUGE LA
70810-7827
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-2222
  • Fax: 225-766-2068
Mailing address:
  • Phone: 225-769-2222
  • Fax: 225-766-2068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDIE A TUCKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 225-408-6900