Provider Demographics
NPI:1326466954
Name:LOUISIANA COLLEGE
Entity Type:Organization
Organization Name:LOUISIANA COLLEGE
Other - Org Name:LOUISIANA COLLEGE SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SERVICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-598-1663
Mailing Address - Street 1:1140 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71359-3995
Mailing Address - Country:US
Mailing Address - Phone:318-487-7792
Mailing Address - Fax:972-367-3451
Practice Address - Street 1:1140 COLLEGE DR
Practice Address - Street 2:BOX 563
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71359-1000
Practice Address - Country:US
Practice Address - Phone:318-487-7792
Practice Address - Fax:318-487-7174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty