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General NPI Number Information
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NPI Number | 1275780181
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Entity Type | Organization
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Legal Business Name | ADVANCED SPORTS INJURY & SPINAL CARE LLC
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 1322 ELTON RD STE K
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City | JENNINGS
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State | LA
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Zip | 70546-4100
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Country | US
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Telephone | 337-824-2901
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Fax |
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Provider Business Mailing Address
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Address Line | 1322 ELTON RD STE K
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City | JENNINGS
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State | LA
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Zip | 70546-4100
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Country | US
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Telephone | 337-824-2901
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Fax |
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Authorized Official
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Title or Position | OFFICE MGR
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Name | MR. LISA G GODDARD
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Credential |
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Telephone | 337-824-2901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 1430
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License Number State | LA
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