Healthcare Provider Details

I. General information

NPI: 1649215765
Provider Name (Legal Business Name): BROUSSARD SURGERY INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 PECANLAND RD SUITE E-1
MONROE LA
71203-7011
US

IV. Provider business mailing address

1250 PECANLAND RD SUITE E-1
MONROE LA
71203-7011
US

V. Phone/Fax

Practice location:
  • Phone: 318-387-2015
  • Fax: 318-387-2097
Mailing address:
  • Phone: 318-387-2015
  • Fax: 318-387-2097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number124
License Number StateLA

VIII. Authorized Official

Name: DANICA G NELSON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 318-387-2015