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General NPI Number Information
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NPI Number | 1922815240
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Entity Type | Organization
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Legal Business Name | LOUISIANA STAT CARE LLC
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 11055 SHOE CREEK DR
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City | BATON ROUGE
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State | LA
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Zip | 70818-4022
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Country | US
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Telephone | 225-261-4493
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Fax | 866-657-2791
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Provider Business Mailing Address
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Address Line | 11055 SHOE CREEK DR
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City | BATON ROUGE
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State | LA
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Zip | 70818-4022
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Country | US
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Telephone | 225-261-4493
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Fax | 866-657-2791
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Authorized Official
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Title or Position | MD
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Name | NORMAN GLEN NEAL
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Credential | MD
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Telephone | 504-909-0193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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