Provider Demographics
NPI:1972069961
Name:BAYOU PAIN AND SPINE LLC
Entity Type:Organization
Organization Name:BAYOU PAIN AND SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTEMUS
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAGG
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:985-288-5088
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70459-0100
Mailing Address - Country:US
Mailing Address - Phone:985-288-5088
Mailing Address - Fax:985-259-8803
Practice Address - Street 1:1810 LINDBERG DR STE 3500
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8161
Practice Address - Country:US
Practice Address - Phone:985-288-5088
Practice Address - Fax:985-259-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty