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General NPI Number Information
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NPI Number | 1023818010
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Entity Type | Organization
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Legal Business Name | BATON ROUGE ORTHOPAEDIC CLINIC LLC
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 5000 ODONAVAN BLVD STE 518
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City | WALKER
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State | LA
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Zip | 70785-6353
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Country | US
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Telephone | 225-380-1312
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Fax | 225-380-1314
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Provider Business Mailing Address
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Address Line | 8080 BLUEBONNET BLVD STE 1000
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City | BATON ROUGE
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State | LA
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Zip | 70810-7827
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Country | US
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Telephone | 225-924-2424
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SAMUEL WILLIAMSON
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Credential |
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Telephone | 225-924-2424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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