Provider Demographics
NPI:1396116737
Name:LEVEL 1 ORTHOPEDICS & SPINE, LLC
Entity type:Organization
Organization Name:LEVEL 1 ORTHOPEDICS & SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-281-2055
Mailing Address - Street 1:15711 PHILEMON THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-5622
Mailing Address - Country:US
Mailing Address - Phone:225-281-2055
Mailing Address - Fax:
Practice Address - Street 1:15711 PHILEMON THOMAS DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-5622
Practice Address - Country:US
Practice Address - Phone:225-281-2055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies