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General NPI Number Information
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NPI Number | 1699596684
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Entity Type | Organization
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Legal Business Name | RISE PHYSICIAN GROUP LLC
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Dates
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Enumeration Date | 10/22/2024
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 37358 MARKET PLACE DR
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City | PRAIRIEVILLE
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State | LA
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Zip | 70769-3482
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Country | US
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Telephone | 512-948-1752
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Fax |
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Provider Business Mailing Address
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Address Line | 37358 MARKET PLACE DR
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City | PRAIRIEVILLE
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State | LA
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Zip | 70769-3482
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Country | US
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Telephone | 225-755-9765
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PATIENT ACCESS
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Name | NICOLE CAMPBELL
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Credential |
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Telephone | 512-948-1752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 104100000X
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Taxonomy Name | Social Worker
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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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 | 207LA0401X
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Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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