Provider Demographics
NPI:1164734844
Name:LOUISIANA DYSPHAGIA CONSULTANTS, L.L.C.
Entity Type:Organization
Organization Name:LOUISIANA DYSPHAGIA CONSULTANTS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:BAUMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-275-1834
Mailing Address - Street 1:6078 BRIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1126
Mailing Address - Country:US
Mailing Address - Phone:805-275-1834
Mailing Address - Fax:877-293-1573
Practice Address - Street 1:233 SUMMER RIDGE LOOP
Practice Address - Street 2:
Practice Address - City:SUNSET
Practice Address - State:LA
Practice Address - Zip Code:70584-5057
Practice Address - Country:US
Practice Address - Phone:877-787-9846
Practice Address - Fax:877-787-9377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DP52Medicare PIN