Healthcare Provider Details

I. General information

NPI: 1164697983
Provider Name (Legal Business Name): BATON ROUGE ORTHOPAEDIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 W HIGHWAY 30
GONZALES LA
70737-5002
US

IV. Provider business mailing address

8080 BLUEBONNET BLVD SUITE 1000
BATON ROUGE LA
70810-7827
US

V. Phone/Fax

Practice location:
  • Phone: 225-743-2366
  • Fax: 225-743-2369
Mailing address:
  • Phone: 225-924-2424
  • Fax: 225-408-7984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MARY C BOWLIN
Title or Position: CREDENTIALS COORDINATOR
Credential:
Phone: 985-974-0422