Basic Information
| Provider Information | |||||||||
| NPI: | 1851876270 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUISIANA ORTHOPAEDIC SPECIALIST, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 N LEWIS ST STE 280 | ||||||||
| Address2: | |||||||||
| City: | NEW IBERIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705632046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372358007 | ||||||||
| FaxNumber: | 8552705479 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 N LEWIS ST STE 280 | ||||||||
| Address2: | |||||||||
| City: | NEW IBERIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705632046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372358007 | ||||||||
| FaxNumber: | 8552705479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2018 | ||||||||
| LastUpdateDate: | 10/02/2018 | ||||||||
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| AuthorizedOfficialLastName: | GUIDRY | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OT | ||||||||
| AuthorizedOfficialTelephone: | 3372358007 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.