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General NPI Number Information
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NPI Number | 1760986996
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Entity Type | Organization
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Legal Business Name | RNB SURGICAL SERVICES LLC
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 03/21/2018
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Provider Practice Location Address
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Address Line | 19343 SUNSHINE AVE
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City | COVINGTON
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State | LA
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Zip | 70433-5160
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Country | US
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Telephone | 985-892-5117
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Fax | 985-898-5932
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Provider Business Mailing Address
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Address Line | 301 E 7TH AVE
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City | COVINGTON
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State | LA
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Zip | 70433-4119
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Country | US
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Telephone | 337-298-8308
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Fax |
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Authorized Official
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Title or Position | OWNER/ MEMBER
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Name | MISS RACHEL BROUSSARD
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Credential | OPA-C, CSFA
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Telephone | 337-298-8308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZX2200X
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Taxonomy Name | Orthopedic Assistant
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License Number | 1284
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 170337
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License Number State | LA
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