Provider Demographics
NPI:1659360964
Name:HANSBROUGH, PETERS, TRAXLER & SCALLAN MEDICAL ASSOCIATION, INC.
Entity Type:Organization
Organization Name:HANSBROUGH, PETERS, TRAXLER & SCALLAN MEDICAL ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HIDALGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-408-6729
Mailing Address - Street 1:8080 BLUEBONNET BLVD
Mailing Address - Street 2:STE. 2121
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7827
Mailing Address - Country:US
Mailing Address - Phone:225-767-7200
Mailing Address - Fax:225-767-7386
Practice Address - Street 1:8080 BLUEBONNET BLVD
Practice Address - Street 2:STE. 2121
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-7827
Practice Address - Country:US
Practice Address - Phone:225-767-7200
Practice Address - Fax:225-767-7386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DR48Medicare PIN