Provider Demographics
NPI:1043397672
Name:CENTER FOR ORTHOPAEDICS
Entity Type:Organization
Organization Name:CENTER FOR ORTHOPAEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:JANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-721-7236
Mailing Address - Street 1:PO BOX 1807
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602-1807
Mailing Address - Country:US
Mailing Address - Phone:337-626-7630
Mailing Address - Fax:337-626-8409
Practice Address - Street 1:250 BEGLIS PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-3500
Practice Address - Country:US
Practice Address - Phone:337-626-7630
Practice Address - Fax:337-626-8409
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR ORTHOPAEDICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207X00000X, 208100000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1945111Medicaid
LACI9478OtherRAILROAD MEDICARE GROUP
LA5D847Medicare ID - Type UnspecifiedMCR GROUP PROVIDER #