Provider Demographics
NPI:1174615314
Name:BATON ROUGE ORTHOTICS & PROSTHETICS
Entity type:Organization
Organization Name:BATON ROUGE ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-767-6264
Mailing Address - Street 1:5745 ESSEN LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1115
Mailing Address - Country:US
Mailing Address - Phone:225-767-6264
Mailing Address - Fax:225-767-0311
Practice Address - Street 1:5745 ESSEN LN
Practice Address - Street 2:SUITE 102
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1115
Practice Address - Country:US
Practice Address - Phone:225-767-6264
Practice Address - Fax:225-767-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA400246335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1361143Medicaid
LA0336030001Medicare ID - Type Unspecified