Provider Demographics
NPI:1669760948
Name:BATON ROUGE GENERAL PRIMARY CARE, LLC
Entity type:Organization
Organization Name:BATON ROUGE GENERAL PRIMARY CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-237-1645
Mailing Address - Street 1:8490 PICARDY AVE
Mailing Address - Street 2:BLDG 200
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3731
Mailing Address - Country:US
Mailing Address - Phone:225-237-1754
Mailing Address - Fax:225-237-1722
Practice Address - Street 1:8585 PICARDY AVE
Practice Address - Street 2:SUITE 513
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3679
Practice Address - Country:US
Practice Address - Phone:225-819-1198
Practice Address - Fax:225-819-1189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BATON ROUGE GENERAL PRIMARY CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-20
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DV54OtherMEDICARE GROUP PTAN