Provider Demographics
NPI:1538673694
Name:ADVANCED PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:ADVANCED PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:EATON
Authorized Official - Last Name:BOUSSERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-278-4292
Mailing Address - Street 1:6536 LASALLE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7318
Mailing Address - Country:US
Mailing Address - Phone:318-278-4292
Mailing Address - Fax:
Practice Address - Street 1:6536 LASALLE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7318
Practice Address - Country:US
Practice Address - Phone:318-278-4292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty