Healthcare Provider Details

I. General information

NPI: 1760986996
Provider Name (Legal Business Name): RNB SURGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19343 SUNSHINE AVE
COVINGTON LA
70433-5160
US

IV. Provider business mailing address

301 E 7TH AVE
COVINGTON LA
70433-4119
US

V. Phone/Fax

Practice location:
  • Phone: 985-892-5117
  • Fax: 985-898-5932
Mailing address:
  • Phone: 337-298-8308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number170337
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number1284
License Number StateLA

VIII. Authorized Official

Name: MISS RACHEL BROUSSARD
Title or Position: OWNER/ MEMBER
Credential: OPA-C, CSFA
Phone: 337-298-8308