MEDICARE: LOS ORTHOPAEDIC AND SPINE SURGERY CENTER, LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1457127938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS ORTHOPAEDIC AND SPINE SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	300 E BLUEBIRD DRIVE
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-5739
Country	:	US
Telephone Number	:	337-889-3001
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E BLUEBIRD DRIVE
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508
Country	:	US
Telephone Number	:	337-235-8007
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	MRS. AMANDA GUIDRY
Credential	:
Telephone Number	:	337-889-3108

Provider Enumeration Date	:	11/27/2023
Last Update Date	:	04/09/2026

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