Provider Demographics
NPI:1215236229
Name:WOMAN'S SURGICAL SPECIALTY GROUP
Entity type:Organization
Organization Name:WOMAN'S SURGICAL SPECIALTY GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:G
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-927-1300
Mailing Address - Street 1:9050 AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4103
Mailing Address - Country:US
Mailing Address - Phone:225-927-1300
Mailing Address - Fax:225-922-3745
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 702
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-924-8338
Practice Address - Fax:225-922-3745
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOMAN'S HOSPITAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.019326208600000X
LAMD.017436208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty