Provider Demographics
NPI:1598267262
Name:BATON ROUGE INTERVENTIONAL PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:BATON ROUGE INTERVENTIONAL PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:225-442-3166
Mailing Address - Street 1:PO BOX 77878
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70879-7878
Mailing Address - Country:US
Mailing Address - Phone:225-442-3166
Mailing Address - Fax:
Practice Address - Street 1:4460 BLUEBONNET BLVD STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-9658
Practice Address - Country:US
Practice Address - Phone:225-442-3166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty