Provider Demographics
NPI:1316146228
Name:ORTHOPAEDIC SPORTS SPECIALISTS OF LOUISIANA LLC
Entity type:Organization
Organization Name:ORTHOPAEDIC SPORTS SPECIALISTS OF LOUISIANA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-625-2200
Mailing Address - Street 1:726 N ACADIA RD STE 1000
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-5051
Mailing Address - Country:US
Mailing Address - Phone:985-625-2200
Mailing Address - Fax:985-625-2206
Practice Address - Street 1:726 N ACADIA RD STE 1000
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-5051
Practice Address - Country:US
Practice Address - Phone:985-625-2200
Practice Address - Fax:985-625-2206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1821049743OtherDR'S INDIVIDUAL NPI
LA1821049743OtherDR'S INDIVIDUAL NPI