MEDICARE: CENTER FOR ORTHOPAEDICS AND SPINE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2086S0105X	Surgery of the Hand (Surgery) Physician
2	208VP0014X	Interventional Pain Medicine Physician
3	213ES0103X	Foot & Ankle Surgery Podiatrist
4	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician
5	208100000X	Physical Medicine & Rehabilitation Physician
6	207QS0010X	Sports Medicine (Family Medicine) Physician
7	207T00000X	Neurological Surgery Physician
8	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1134877392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR ORTHOPAEDICS AND SPINE LLC

Provider Business Mailing Address
First Line	:	1747 IMPERIAL BLVD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5362
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1355 SAM HOUSTON JONES PKWY STE 340
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70611-5473
Country	:	US
Telephone Number	:	337-721-7236
Fax Number	:	337-721-7237

Authorized Official
Title or Position	:	MANAGER MEMBER
Name	:	JOHN WALLACE NOBLE JR.
Credential	:	MD
Telephone Number	:	337-721-7242

Provider Enumeration Date	:	03/16/2022
Last Update Date	:	03/16/2022

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Directions to “CENTER FOR ORTHOPAEDICS AND SPINE LLC ” Practice Location

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