Provider Demographics
NPI:1255565222
Name:PATRICK R. ELLENDER, M.D., L.L.C.
Entity type:Organization
Organization Name:PATRICK R. ELLENDER, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:MARE
Authorized Official - Last Name:LEGENDRE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:985-625-2200
Mailing Address - Street 1:604 N ACADIA RD
Mailing Address - Street 2:SUITE 508
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4897
Mailing Address - Country:US
Mailing Address - Phone:985-625-2200
Mailing Address - Fax:985-625-2206
Practice Address - Street 1:604 N ACADIA RD
Practice Address - Street 2:SUITE 508
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4897
Practice Address - Country:US
Practice Address - Phone:985-625-2200
Practice Address - Fax:985-625-2206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA236379207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty