Provider Demographics
NPI:1720026727
Name:BAYOU STATE GROUP, INC
Entity Type:Organization
Organization Name:BAYOU STATE GROUP, INC
Other - Org Name:BAYOU STATE MEDICAL AND REHAB CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FREDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-546-0101
Mailing Address - Street 1:PO BOX 65208
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-5208
Mailing Address - Country:US
Mailing Address - Phone:225-925-3020
Mailing Address - Fax:225-925-9807
Practice Address - Street 1:1021 E LAUREL ST
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535
Practice Address - Country:US
Practice Address - Phone:337-546-0101
Practice Address - Fax:337-546-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CP24Medicare ID - Type Unspecified