MEDICARE: SPS PROVIDER NETWORK

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	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1902752736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPS PROVIDER NETWORK

Provider Business Mailing Address
First Line	:	6028 MAGAZINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70118-5824
Country	:	US
Telephone Number	:	504-800-8058
Fax Number	:	504-387-6538

Provider Business Practice Location Address
First Line	:	6028 MAGAZINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70118-5824
Country	:	US
Telephone Number	:	504-800-8058
Fax Number	:	504-387-6538

Authorized Official
Title or Position	:	MANAGER
Name	:	ANGIE HARDEN
Credential	:
Telephone Number	:	504-800-8058

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “SPS PROVIDER NETWORK ” Practice Location

Language	Start Address	Practice Location

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