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General NPI Number Information
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NPI Number | 1295535144
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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 | 42078 VETERANS AVE STE B
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City | HAMMOND
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State | LA
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Zip | 70403-1490
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Country | US
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Telephone | 225-490-3070
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Fax |
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) 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 | 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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Taxonomy #3
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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 #4
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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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