Provider Demographics
NPI:1104569524
Name:ROSEBUD HEALTHCARE AND TRAINING
Entity type:Organization
Organization Name:ROSEBUD HEALTHCARE AND TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VIKKI
Authorized Official - Middle Name:SPURLOCK
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-229-3254
Mailing Address - Street 1:3024 WESTFORK DR STE B
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2252
Mailing Address - Country:US
Mailing Address - Phone:225-256-2918
Mailing Address - Fax:225-380-2171
Practice Address - Street 1:3024 WESTFORK DR STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2252
Practice Address - Country:US
Practice Address - Phone:225-256-2918
Practice Address - Fax:225-380-2171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty