Provider Demographics
NPI:1598001794
Name:NEUROTECH OF LOUISIANA, LLC
Entity type:Organization
Organization Name:NEUROTECH OF LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM
Authorized Official - Phone:985-778-3148
Mailing Address - Street 1:194 LA TOUR BLVD
Mailing Address - Street 2:
Mailing Address - City:MATHEWS
Mailing Address - State:LA
Mailing Address - Zip Code:70375-2402
Mailing Address - Country:US
Mailing Address - Phone:985-778-3148
Mailing Address - Fax:800-786-0683
Practice Address - Street 1:194 LA TOUR BLVD
Practice Address - Street 2:
Practice Address - City:MATHEWS
Practice Address - State:LA
Practice Address - Zip Code:70375-2402
Practice Address - Country:US
Practice Address - Phone:985-778-3148
Practice Address - Fax:800-786-0683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty