Basic Information
| Provider Information | |||||||||
| NPI: | 1881717577 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BATON ROUGE ORTHOPAEDIC CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3642 ALLENE ST | ||||||||
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| City: | BRUSLY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707192085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257497660 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8080 BLUEBONNET BLVD | ||||||||
| Address2: | 1000 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708107827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259242424 | ||||||||
| FaxNumber: | 2254087929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 09/07/2007 | ||||||||
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| AuthorizedOfficialLastName: | ST. CYR | ||||||||
| AuthorizedOfficialFirstName: | ANNE | ||||||||
| AuthorizedOfficialMiddleName: | SCHUPBACH | ||||||||
| AuthorizedOfficialTitleorPosition: | RADIOLOGIC TECHNOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 2259242424 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BATON ROUGE ORTHOPAEDIC CLINIC | ||||||||
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| AuthorizedOfficialCredential: | R.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | 7009 | LA | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.