Provider Demographics
NPI:1881600708
Name:BIAS, RONNIE WAYNE (CPO)
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:WAYNE
Last Name:BIAS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-1529
Mailing Address - Country:US
Mailing Address - Phone:337-474-2989
Mailing Address - Fax:337-474-2996
Practice Address - Street 1:505 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-1529
Practice Address - Country:US
Practice Address - Phone:337-474-2989
Practice Address - Fax:337-474-2996
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPO02273222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1457396Medicaid
SC5772080001Medicare NSC