Provider Demographics
NPI:1952943417
Name:ORTHOPAEDIC SPORTS SPECIALISTS OF LOUISIANA, LLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPORTS SPECIALISTS OF LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-625-2200
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-0028
Mailing Address - Country:US
Mailing Address - Phone:985-625-2200
Mailing Address - Fax:985-625-2206
Practice Address - Street 1:180 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2766
Practice Address - Country:US
Practice Address - Phone:985-625-2200
Practice Address - Fax:985-625-2206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty