Provider Demographics
NPI:1821344516
Name:ORTHOPEDIC CARE CENTER OF LOUISIANA
Entity Type:Organization
Organization Name:ORTHOPEDIC CARE CENTER OF LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-926-3343
Mailing Address - Street 1:4550 NORTH BLVD
Mailing Address - Street 2:STE. 101
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4013
Mailing Address - Country:US
Mailing Address - Phone:225-926-3343
Mailing Address - Fax:225-926-8663
Practice Address - Street 1:4550 NORTH BLVD
Practice Address - Street 2:STE. 101
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4013
Practice Address - Country:US
Practice Address - Phone:225-926-3343
Practice Address - Fax:225-926-8663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA15788R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty