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General NPI Number Information
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NPI Number | 1154309318
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Entity Type | Organization
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Legal Business Name | RED STICK CARDIOLOGY LLC
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Dates
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Enumeration Date | 01/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 17050 MEDICAL CENTER DR STE 111
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City | BATON ROUGE
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State | LA
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Zip | 70816-3252
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Country | US
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Telephone | 225-753-8686
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Fax | 225-753-8774
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Provider Business Mailing Address
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Address Line | 17050 MEDICAL CENTER DR STE 111
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City | BATON ROUGE
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State | LA
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Zip | 70816-3252
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Country | US
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Telephone | 225-753-8686
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Fax | 225-753-8774
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CHARLES ALLEN THOMPSON
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Credential | MD
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Telephone | 225-753-8686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 10749R
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License Number State | LA
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