=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508745324
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUEBONNET SURGICAL CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2025
-----------------------------------------------------
Last Update Date | 08/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5049 BLUEBONNET BLVD
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70809-3084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-334-8040
-----------------------------------------------------
Fax | 225-269-5146
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5049 BLUEBONNET BLVD
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70809-3084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-334-8040
-----------------------------------------------------
Fax | 225-269-5146
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | ERICK ROY SANCHEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 409-772-8119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------