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NPI Code Detail

MEDICARE: LOUISIANA REGENERATIVE MEDICINE CENTER

MEDICARE: LOUISIANA REGENERATIVE MEDICINE CENTER
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
1261QP3300XPain Clinic/Center

General Provider Information

NPI Number : 1790301596
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOUISIANA REGENERATIVE MEDICINE CENTER
Provider Business Mailing Address
First Line : 9456 JEFFERSON HWY
Second Line : ST A
City : BATON ROUGE
State : LA
Zip : 70809-2883
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9456 JEFFERSON HWY ST A
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809
Country : US
Telephone Number : 225-716-9100
Fax Number :
Authorized Official
Title or Position : OFFICE MANAGER
Name : ELIZABETH R CONSTANT
Credential :
Telephone Number : 985-414-4530
Provider Enumeration Date : 06/18/2020
Last Update Date : 06/18/2020

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Directions to “LOUISIANA REGENERATIVE MEDICINE CENTER ” Practice Location

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