Healthcare Provider Details

I. General information

NPI: 1215208335
Provider Name (Legal Business Name): BAYOU WORK READY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 CHESTNUT ST
NEW ORLEANS LA
70115-3615
US

IV. Provider business mailing address

2626 S LOOP W SUITE 522
HOUSTON TX
77054-2654
US

V. Phone/Fax

Practice location:
  • Phone: 504-208-5522
  • Fax: 504-208-5511
Mailing address:
  • Phone: 713-661-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. SHARLETTE MORRIS
Title or Position: BILLING MANAGER
Credential:
Phone: 713-661-2100