Provider Demographics
NPI:1891772547
Name:NOVAMED SURGERY CENTER OF BATON ROUGE LLC
Entity Type:Organization
Organization Name:NOVAMED SURGERY CENTER OF BATON ROUGE LLC
Other - Org Name:INTERVENTIONAL PAIN MANAGEMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5900
Mailing Address - Street 1:8748 BLUEBONNET BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2817
Mailing Address - Country:US
Mailing Address - Phone:225-329-2900
Mailing Address - Fax:225-329-2901
Practice Address - Street 1:8748 BLUEBONNET BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2817
Practice Address - Country:US
Practice Address - Phone:225-329-2900
Practice Address - Fax:225-329-2901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA140261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19-C0001098Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER