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General NPI Number Information
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NPI Number | 1467409672
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Entity Type | Organization
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Legal Business Name | LOUISIANA EDOSCOPY CENTER, INC.
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9103 JEFFERSON HWY
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City | BATON ROUGE
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State | LA
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Zip | 70809-2440
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Country | US
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Telephone | 225-927-1190
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Fax | 225-231-8819
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Provider Business Mailing Address
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Address Line | 9103 JEFFERSON HWY
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City | BATON ROUGE
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State | LA
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Zip | 70809-2440
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Country | US
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Telephone | 225-927-1190
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Fax | 225-231-8819
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CHARLES C. BERGGREEM
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Credential | M.D.
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Telephone | 225-927-1190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number | 46
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License Number State | LA
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