Healthcare Provider Details

I. General information

NPI: 1073387338
Provider Name (Legal Business Name): PONTCHARTRAIN BONE & JOINT CLINIC, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14041 HWY 90
BOUTTE LA
70039-3511
US

IV. Provider business mailing address

3939 HOUMA BLVD STE 21
METAIRIE LA
70006-2921
US

V. Phone/Fax

Practice location:
  • Phone: 985-764-3001
  • Fax: 985-308-1458
Mailing address:
  • Phone: 506-885-6464
  • Fax: 504-247-0562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY J SKETCHLER
Title or Position: OWNER
Credential: MD
Phone: 504-885-6464