Provider Demographics
NPI:1952488033
Name:LON M BARONNE DPM BARONNE FOOT CENTER
Entity Type:Organization
Organization Name:LON M BARONNE DPM BARONNE FOOT CENTER
Other - Org Name:BARONNE FOOT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-942-7567
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-0159
Mailing Address - Country:US
Mailing Address - Phone:337-942-7567
Mailing Address - Fax:337-948-4993
Practice Address - Street 1:2848 S UNION ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5738
Practice Address - Country:US
Practice Address - Phone:337-948-7567
Practice Address - Fax:337-948-4993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1021831Medicaid
LA5C796Medicare PIN
LA0479060001Medicare NSC