Provider Demographics
NPI:1639224355
Name:SURGICAL SPECIALTY GROUP, INC.
Entity Type:Organization
Organization Name:SURGICAL SPECIALTY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA,FACS
Authorized Official - Phone:225-769-5656
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 612
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-769-5656
Mailing Address - Fax:225-766-6996
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 612
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-769-5656
Practice Address - Fax:225-766-6996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1940348Medicaid
LA57692Medicare ID - Type Unspecified