Basic Information
| Provider Information | |||||||||
| NPI: | 1275714297 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MINIMALLY INVASIVE SURGERY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 66577 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708966577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253812660 | ||||||||
| FaxNumber: | 2253812638 | ||||||||
| Practice Location | |||||||||
| Address1: | 3600 FLORIDA BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708063842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253812660 | ||||||||
| FaxNumber: | 2253812638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2007 | ||||||||
| LastUpdateDate: | 08/29/2011 | ||||||||
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| AuthorizedOfficialLastName: | SHARON | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | LANDRY | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2253812660 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 15173R | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.