MEDICARE: LOUISIANA DYSPHAGIA CONSULTANTS, L.L.C.

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1164734844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISIANA DYSPHAGIA CONSULTANTS, L.L.C.

Provider Business Mailing Address
First Line	:	6078 BRIDGEVIEW DR
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93003-1126
Country	:	US
Telephone Number	:	805-275-1834
Fax Number	:	877-293-1573

Provider Business Practice Location Address
First Line	:	233 SUMMER RIDGE LOOP
Second Line	:
City	:	SUNSET
State	:	LA
Zip	:	70584-5057
Country	:	US
Telephone Number	:	877-787-9846
Fax Number	:	877-787-9377

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. BENJAMIN LOUIS BAUMER
Credential	:
Telephone Number	:	805-275-1834

Provider Enumeration Date	:	07/09/2010
Last Update Date	:	02/01/2012

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