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General NPI Number Information
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NPI Number | 1538780630
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Entity Type | Organization
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Legal Business Name | CENTER FOR ORTHOPAEDICS AND SPINE, LLC
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Dates
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Enumeration Date | 04/29/2020
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Last Update Date | 05/07/2020
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Provider Practice Location Address
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Address Line | 1727 IMPERIAL BLVD BLDG 1B
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City | LAKE CHARLES
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State | LA
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Zip | 70605-5392
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Country | US
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Telephone | 337-721-7236
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Fax |
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Provider Business Mailing Address
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Address Line | 1747 IMPERIAL BLVD
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City | LAKE CHARLES
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State | LA
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Zip | 70605-5362
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER MEMBER
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Name | JOHN WALLACE NOBLE
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Credential | MD
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Telephone | 337-721-7242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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