MEDICARE: GREATER BATON ROUGE SURGICAL HOSPITAL, 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	282N00000X	General Acute Care Hospital	574	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487645859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER BATON ROUGE SURGICAL HOSPITAL, LLC

Provider Business Mailing Address
First Line	:	7855 HOWELL BOULEVARD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70807
Country	:	US
Telephone Number	:	225-358-4900
Fax Number	:	225-358-4901

Provider Business Practice Location Address
First Line	:	7855 HOWELL BOULEVARD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70807
Country	:	US
Telephone Number	:	225-358-4900
Fax Number	:	225-358-4901

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. ROBERT D. BLAIR
Credential	:
Telephone Number	:	225-358-4900

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	05/14/2009

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