Provider Demographics
NPI:1780637223
Name:LOUISIANA INSTITUTE OF PHYSICAL MEDICINE & FAMILY PRACTICE
Entity Type:Organization
Organization Name:LOUISIANA INSTITUTE OF PHYSICAL MEDICINE & FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-766-1616
Mailing Address - Street 1:PO BOX 84330
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884
Mailing Address - Country:US
Mailing Address - Phone:225-766-1616
Mailing Address - Fax:225-766-2645
Practice Address - Street 1:8338 SUMMA AVE
Practice Address - Street 2:STE 500
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3669
Practice Address - Country:US
Practice Address - Phone:225-766-1616
Practice Address - Fax:225-766-2645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08510R2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA174480700OtherACS-DEPT OF LABOR
LAG1573OtherBLUE CROSS BLUE SHIELD
LAG1573OtherBLUE CROSS BLUE SHIELD