Provider Demographics
NPI:1871823740
Name:LOUISIANA PAIN SPECIALISTS, LLC
Entity Type:Organization
Organization Name:LOUISIANA PAIN SPECIALISTS, LLC
Other - Org Name:SOUTHERN PAIN RELIEF
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-754-2334
Mailing Address - Street 1:2706 HESSMER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-7046
Mailing Address - Country:US
Mailing Address - Phone:504-754-2334
Mailing Address - Fax:504-324-2078
Practice Address - Street 1:4520 WICHERS DR
Practice Address - Street 2:SUITE 205
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3135
Practice Address - Country:US
Practice Address - Phone:504-754-2334
Practice Address - Fax:504-324-2078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2164040Medicaid
LA5DM39Medicare PIN