Provider Demographics
NPI:1578072427
Name:SPINEMARK BATON ROUGE, LLC
Entity Type:Organization
Organization Name:SPINEMARK BATON ROUGE, LLC
Other - Org Name:SPINEMARK NEUROSPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-335-8254
Mailing Address - Street 1:505 E AIRPORT AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6515
Mailing Address - Country:US
Mailing Address - Phone:858-658-0044
Mailing Address - Fax:858-658-0050
Practice Address - Street 1:505 E AIRPORT AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6515
Practice Address - Country:US
Practice Address - Phone:858-658-0044
Practice Address - Fax:858-658-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical