Provider Demographics
NPI:1861905291
Name:SPINEMARK BATON ROUGE CLINIC LLC
Entity type:Organization
Organization Name:SPINEMARK BATON ROUGE CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-335-8254
Mailing Address - Street 1:6020 CORNERSTONE CT W STE 230
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3729
Mailing Address - Country:US
Mailing Address - Phone:858-658-0044
Mailing Address - Fax:858-658-0050
Practice Address - Street 1:455 E AIRPORT AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4832
Practice Address - Country:US
Practice Address - Phone:225-570-2300
Practice Address - Fax:225-570-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty