Provider Demographics
NPI:1164697983
Name:BATON ROUGE ORTHOPAEDIC CLINIC
Entity Type:Organization
Organization Name:BATON ROUGE ORTHOPAEDIC CLINIC
Other - Org Name:ASCENSION ORTHOPAEDIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOWLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-974-0422
Mailing Address - Street 1:8080 BLUEBONNET BLVD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7827
Mailing Address - Country:US
Mailing Address - Phone:225-924-2424
Mailing Address - Fax:225-408-7984
Practice Address - Street 1:1023 W HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5002
Practice Address - Country:US
Practice Address - Phone:225-743-2366
Practice Address - Fax:225-743-2369
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BATON ROUGE ORTHOPAEDIC CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-23
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1793418Medicaid
LA5C811Medicare PIN
LA4214660003Medicare NSC