Provider Demographics
NPI:1588631311
Name:SURGICAL SPECIALTY CENTER OF BATON ROUGE, LLC
Entity Type:Organization
Organization Name:SURGICAL SPECIALTY CENTER OF BATON ROUGE, LLC
Other - Org Name:SURGICAL SPECIALTY CENTER OF BATON ROUGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-408-5548
Mailing Address - Street 1:8080 BLUEBONNET BLVD.
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810
Mailing Address - Country:US
Mailing Address - Phone:225-408-8080
Mailing Address - Fax:225-408-5569
Practice Address - Street 1:8080 BLUEBONNET BLVD.
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810
Practice Address - Country:US
Practice Address - Phone:225-408-8080
Practice Address - Fax:225-408-5569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA496282N00000X
LA645282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1702358Medicaid
LA1702358Medicaid