Provider Demographics
NPI:1275796070
Name:BATON ROUGE ORTHOPAEDIC CLINIC LLC
Entity Type:Organization
Organization Name:BATON ROUGE ORTHOPAEDIC CLINIC LLC
Other - Org Name:BROCDME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR ANCILLARY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-408-7992
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:
Practice Address - Street 1:8080 BLUEBONNET BLVD
Practice Address - Street 2:SUITE 1000
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-7827
Practice Address - Country:US
Practice Address - Phone:225-924-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BATON ROUGE ORTHOPAEDIC CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier