Provider Demographics
NPI:1831932524
Name:BAYOU ORTHOCARE LLC
Entity type:Organization
Organization Name:BAYOU ORTHOCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:337-534-0219
Mailing Address - Street 1:4630 AMBASSADOR CAFFERY PKWY STE 208B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6949
Mailing Address - Country:US
Mailing Address - Phone:337-466-4666
Mailing Address - Fax:337-466-4829
Practice Address - Street 1:4630 AMBASSADOR CAFFERY PKWY STE 208B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6949
Practice Address - Country:US
Practice Address - Phone:337-466-4666
Practice Address - Fax:337-466-4829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty