Provider Demographics
NPI:1831660596
Name:INJURY TREATMENT CENTER OF LOUISIANA, LLC
Entity Type:Organization
Organization Name:INJURY TREATMENT CENTER OF LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-377-9877
Mailing Address - Street 1:222 N VERMONT ST STE N
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3240
Mailing Address - Country:US
Mailing Address - Phone:985-956-7216
Mailing Address - Fax:985-956-7186
Practice Address - Street 1:15814 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1453
Practice Address - Country:US
Practice Address - Phone:985-956-7216
Practice Address - Fax:985-956-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty