Healthcare Provider Details

I. General information

NPI: 1669926887
Provider Name (Legal Business Name): KINDL WORKS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 LINDBERG DR STE 6
SLIDELL LA
70458
US

IV. Provider business mailing address

1570 LINDBERG DR SUITE 10
SLIDELL LA
70458-8083
US

V. Phone/Fax

Practice location:
  • Phone: 985-326-8614
  • Fax: 985-445-1603
Mailing address:
  • Phone: 985-326-8614
  • Fax: 985-445-1603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA A ROIG
Title or Position: PRACTICE MANAGER
Credential:
Phone: 985-326-8614