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General NPI Number Information
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NPI Number | 1831773837
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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 | 05/06/2021
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 1636 ELTON RD STE 201
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City | JENNINGS
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State | LA
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Zip | 70546-3648
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) 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 | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation 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 | 2086S0105X
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Taxonomy Name | Surgery of the Hand (Surgery) 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 | 208VP0014X
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Taxonomy Name | Interventional Pain 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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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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 | 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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