Provider Demographics
NPI:1700894896
Name:BATON ROUGE EAR, NOSE & THROAT ASSOC.
Entity Type:Organization
Organization Name:BATON ROUGE EAR, NOSE & THROAT ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EDIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCULLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-408-6900
Mailing Address - Street 1:8080 BLUEBONNET BLVD
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7827
Mailing Address - Country:US
Mailing Address - Phone:225-769-2222
Mailing Address - Fax:225-766-2068
Practice Address - Street 1:8080 BLUEBONNET BLVD
Practice Address - Street 2:SUITE 2222
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-7827
Practice Address - Country:US
Practice Address - Phone:225-769-2222
Practice Address - Fax:225-766-2068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1442500Medicaid
LA5C988Medicare ID - Type Unspecified