Provider Demographics
NPI:1548238249
Name:RED STICK ORTHOPEDICS & PROSTHETICS
Entity Type:Organization
Organization Name:RED STICK ORTHOPEDICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:B SC CO
Authorized Official - Phone:225-928-9939
Mailing Address - Street 1:7754 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4706
Mailing Address - Country:US
Mailing Address - Phone:225-928-9939
Mailing Address - Fax:225-928-7388
Practice Address - Street 1:7754 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4706
Practice Address - Country:US
Practice Address - Phone:225-928-9939
Practice Address - Fax:225-928-7388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1121908Medicaid
LA4523500001Medicare ID - Type Unspecified