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General NPI Number Information
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NPI Number | 1790301596
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Entity Type | Organization
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Legal Business Name | LOUISIANA REGENERATIVE MEDICINE CENTER
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Dates
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Enumeration Date | 06/18/2020
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 9456 JEFFERSON HWY ST A
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City | BATON ROUGE
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State | LA
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Zip | 70809
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Country | US
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Telephone | 225-716-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 9456 JEFFERSON HWY ST A
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City | BATON ROUGE
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State | LA
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Zip | 70809-2883
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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 | OFFICE MANAGER
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Name | ELIZABETH R CONSTANT
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Credential |
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Telephone | 985-414-4530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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