Provider Demographics
NPI:1275714297
Name:MINIMALLY INVASIVE SURGERY, LLC
Entity Type:Organization
Organization Name:MINIMALLY INVASIVE SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LANDRY
Authorized Official - Last Name:SHARON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:225-381-2660
Mailing Address - Street 1:PO BOX 66577
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-6577
Mailing Address - Country:US
Mailing Address - Phone:225-381-2660
Mailing Address - Fax:225-381-2638
Practice Address - Street 1:3600 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3842
Practice Address - Country:US
Practice Address - Phone:225-381-2660
Practice Address - Fax:225-381-2638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15173R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CT40Medicare PIN