Provider Demographics
NPI:1881717577
Name:BATON ROUGE ORTHOPAEDIC CLINIC
Entity type:Organization
Organization Name:BATON ROUGE ORTHOPAEDIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIC TECHNOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:SCHUPBACH
Authorized Official - Last Name:ST. CYR
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:225-924-2424
Mailing Address - Street 1:3642 ALLENE ST
Mailing Address - Street 2:
Mailing Address - City:BRUSLY
Mailing Address - State:LA
Mailing Address - Zip Code:70719-2085
Mailing Address - Country:US
Mailing Address - Phone:225-749-7660
Mailing Address - Fax:
Practice Address - Street 1:8080 BLUEBONNET BLVD
Practice Address - Street 2:1000
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-7827
Practice Address - Country:US
Practice Address - Phone:225-924-2424
Practice Address - Fax:225-408-7929
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BATON ROUGE ORTHOPAEDIC CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7009261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology