Healthcare Provider Details

I. General information

NPI: 1467540179
Provider Name (Legal Business Name): SPINECARE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 OCHSNER BLVD STE H
GRETNA LA
70056-5256
US

IV. Provider business mailing address

151 OCHSNER BLVD STE H
GRETNA LA
70056-5256
US

V. Phone/Fax

Practice location:
  • Phone: 504-392-7123
  • Fax: 504-392-7823
Mailing address:
  • Phone: 504-392-7123
  • Fax: 504-392-7823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number09377R
License Number StateLA

VIII. Authorized Official

Name: DR. ALEXIS M WAGUESPACK
Title or Position: MD
Credential: MD
Phone: 504-392-7123