MEDICARE: ROSEBUD HEALTHCARE AND TRAINING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1104569524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSEBUD HEALTHCARE AND TRAINING

Provider Business Mailing Address
First Line	:	3024 WESTFORK DR STE B
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2252
Country	:	US
Telephone Number	:	225-256-2918
Fax Number	:	225-380-2171

Provider Business Practice Location Address
First Line	:	3024 WESTFORK DR STE B
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2252
Country	:	US
Telephone Number	:	225-256-2918
Fax Number	:	225-380-2171

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	VIKKI SPURLOCK LEE
Credential	:
Telephone Number	:	225-229-3254

Provider Enumeration Date	:	04/14/2022
Last Update Date	:	04/14/2022

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