Provider Demographics
NPI:1982834966
Name:SPINE INSTITUTE OF SOUTHWEST LOUISIANA, LLC
Entity Type:Organization
Organization Name:SPINE INSTITUTE OF SOUTHWEST LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LASSEIGNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-304-2752
Mailing Address - Street 1:501 W SAINT MARY BLVD
Mailing Address - Street 2:SUITE 416
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-4600
Mailing Address - Country:US
Mailing Address - Phone:504-304-2752
Mailing Address - Fax:504-324-3416
Practice Address - Street 1:501 W SAINT MARY BLVD
Practice Address - Street 2:SUITE 416
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4600
Practice Address - Country:US
Practice Address - Phone:504-304-2752
Practice Address - Fax:504-324-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203148208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty