Healthcare Provider Details

I. General information

NPI: 1003954199
Provider Name (Legal Business Name): LOUISIANA PAIN CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 LAYTON AVENUE SUITE 20
MONROE LA
71210
US

IV. Provider business mailing address

210 LAYTON AVENUE SUITE 20
MONROE LA
71210
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-6405
  • Fax:
Mailing address:
  • Phone: 318-323-6405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateLA

VIII. Authorized Official

Name: MRS. CINDY SHAW
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 318-323-6405