Healthcare Provider Details

I. General information

NPI: 1538305123
Provider Name (Legal Business Name): LOUISIANA PAIN PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2009
Last Update Date: 01/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 E 5TH ST
NATCHITOCHES LA
71457-5725
US

IV. Provider business mailing address

457 ASHLEY RIDGE BLVD
SHREVEPORT LA
71106-7229
US

V. Phone/Fax

Practice location:
  • Phone: 318-352-4477
  • Fax: 318-861-1325
Mailing address:
  • Phone: 318-861-7246
  • Fax: 318-861-1325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAMMY SMITH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 318-861-1336