Provider Demographics
NPI:1942088638
Name:BIOACTIVE INFUSION & WELLNESS OF BATON ROUGE, LLC
Entity Type:Organization
Organization Name:BIOACTIVE INFUSION & WELLNESS OF BATON ROUGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:BERTRAND
Authorized Official - Last Name:GATTE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:888-424-6228
Mailing Address - Street 1:100 W LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578-5912
Mailing Address - Country:US
Mailing Address - Phone:888-424-6228
Mailing Address - Fax:888-612-0595
Practice Address - Street 1:7941 PICARDY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3536
Practice Address - Country:US
Practice Address - Phone:888-424-6228
Practice Address - Fax:888-612-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion TherapyGroup - Multi-Specialty