Provider Demographics
NPI:1619114378
Name:BATON ROUGE MULTI-SPECIALTY CARE CENTER, LLC
Entity Type:Organization
Organization Name:BATON ROUGE MULTI-SPECIALTY CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERTRUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIMEKA-ANYANWOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-202-8850
Mailing Address - Street 1:PO BOX 583
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70821-0583
Mailing Address - Country:US
Mailing Address - Phone:225-289-6803
Mailing Address - Fax:225-289-6483
Practice Address - Street 1:3850 CONVENTION ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3803
Practice Address - Country:US
Practice Address - Phone:225-289-6803
Practice Address - Fax:225-289-6483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5DH40Medicare UPIN