Provider Demographics
NPI:1487645859
Name:GREATER BATON ROUGE SURGICAL HOSPITAL, LLC
Entity Type:Organization
Organization Name:GREATER BATON ROUGE SURGICAL HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-358-4900
Mailing Address - Street 1:7855 HOWELL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70807
Mailing Address - Country:US
Mailing Address - Phone:225-358-4900
Mailing Address - Fax:225-358-4901
Practice Address - Street 1:7855 HOWELL BOULEVARD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807
Practice Address - Country:US
Practice Address - Phone:225-358-4900
Practice Address - Fax:225-358-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA574282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1704245Medicaid
LA19-0273Medicare PIN