Healthcare Provider Details

I. General information

NPI: 1285443366
Provider Name (Legal Business Name): BATON ROUGE CLINIC, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 OLIVER RD
MONROE LA
71201-5702
US

IV. Provider business mailing address

7373 PERKINS RD
BATON ROUGE LA
70808-4373
US

V. Phone/Fax

Practice location:
  • Phone: 318-998-3426
  • Fax:
Mailing address:
  • Phone: 225-246-9790
  • Fax: 225-246-9160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHUNN PHILLIPS
Title or Position: CFO
Credential:
Phone: 225-246-9312