Basic Information
| Provider Information | |||||||||
| NPI: | 1639734973 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BATON ROUGE CLINIC, A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7373 PERKINS RD | ||||||||
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| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708084373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252469790 | ||||||||
| FaxNumber: | 2252469100 | ||||||||
| Practice Location | |||||||||
| Address1: | 8160 YMCA BLVD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257637770 | ||||||||
| FaxNumber: | 2257637773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2019 | ||||||||
| LastUpdateDate: | 05/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | PHILLIPS | ||||||||
| AuthorizedOfficialFirstName: | SHUNN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2257694044 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BATON ROUGE CLINIC, A MEDICAL CORPORATION | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.