Provider Demographics
NPI:1790845287
Name:LOUISIANA BRAIN & SPINE CLINIC, II,LLP
Entity Type:Organization
Organization Name:LOUISIANA BRAIN & SPINE CLINIC, II,LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:V
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-447-2645
Mailing Address - Street 1:604 N ACADIA RD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4847
Mailing Address - Country:US
Mailing Address - Phone:985-447-2645
Mailing Address - Fax:985-447-2604
Practice Address - Street 1:604 N ACADIA RD
Practice Address - Street 2:SUITE 410
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4847
Practice Address - Country:US
Practice Address - Phone:985-447-2645
Practice Address - Fax:985-447-2604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty