Healthcare Provider Details

I. General information

NPI: 1720752827
Provider Name (Legal Business Name): ORTHOPAEDIC SPORTS SPECIALISTS OF LOUISIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 LUTCHER AVE STE 1500
LUTCHER LA
70071-5151
US

IV. Provider business mailing address

PO BOX 28
THIBODAUX LA
70302-0028
US

V. Phone/Fax

Practice location:
  • Phone: 985-625-2200
  • Fax: 985-625-2206
Mailing address:
  • Phone: 985-625-2200
  • Fax: 985-625-2206

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 Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON A. HIGGINS
Title or Position: OWNER
Credential: MD
Phone: 985-625-2200