MEDICARE: INTRATHECAL CARE SERVICES OF LOUISIANA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	208VP0014X	Interventional Pain Medicine Physician
3	2084N0400X	Neurology Physician
4	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
5	251F00000X	Home Infusion Agency
6	208VP0000X	Pain Medicine Physician

General Provider Information

NPI Number	:	1932409521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTRATHECAL CARE SERVICES OF LOUISIANA LLC

Provider Business Mailing Address
First Line	:	PO BOX 612
Second Line	:
City	:	CROWLEY
State	:	LA
Zip	:	70527-0612
Country	:	US
Telephone Number	:	337-783-5010
Fax Number	:	651-436-0399

Provider Business Practice Location Address
First Line	:	228 N PARKERSON AVE
Second Line	:
City	:	CROWLEY
State	:	LA
Zip	:	70526-5003
Country	:	US
Telephone Number	:	337-783-5010
Fax Number	:	651-436-0399

Authorized Official
Title or Position	:	MANAGER
Name	:	KAYLA WASHINGTON
Credential	:	MANAGER
Telephone Number	:	337-783-5010

Provider Enumeration Date	:	10/28/2010
Last Update Date	:	02/08/2026

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