Provider Demographics
NPI:1922150754
Name:BAYOU SURGICAL SPECIALISTS, L.L.C.
Entity type:Organization
Organization Name:BAYOU SURGICAL SPECIALISTS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TARANTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-868-2273
Mailing Address - Street 1:5619 HIGHWAY 311 STE A
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5595
Mailing Address - Country:US
Mailing Address - Phone:985-868-2273
Mailing Address - Fax:985-851-4898
Practice Address - Street 1:5619 HIGHWAY 311 STE A
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5595
Practice Address - Country:US
Practice Address - Phone:985-868-2273
Practice Address - Fax:985-851-4898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1941417Medicaid
LA1941417Medicaid