Provider Demographics
NPI:1821433087
Name:ORTHOPAEDIC RECONSTRUCTIVE SUB-SPECIALISTS, LLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC RECONSTRUCTIVE SUB-SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:FENN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:337-534-0653
Mailing Address - Street 1:301 RUE BEAUREGARD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8520
Mailing Address - Country:US
Mailing Address - Phone:337-534-0653
Mailing Address - Fax:
Practice Address - Street 1:301 RUE BEAUREGARD
Practice Address - Street 2:SUITE C
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8520
Practice Address - Country:US
Practice Address - Phone:337-534-0653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.200825261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAI37944Medicare UPIN