Healthcare Provider Details

I. General information

NPI: 1891507554
Provider Name (Legal Business Name): LOUISIANA PAIN SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 WICHERS DR STE 205
MARRERO LA
70072-3134
US

IV. Provider business mailing address

2706 HESSMER AVE STE A
METAIRIE LA
70002-7046
US

V. Phone/Fax

Practice location:
  • Phone: 504-754-2334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine 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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: CORRIE SPANO
Title or Position: BILLING DIRECTOR
Credential:
Phone: 504-635-2601