Provider Demographics
| NPI: | 1871546911 |
|---|---|
| Name: | BATON ROUGE CLINIC, A MEDICAL CORPORATION |
| Entity type: | Organization |
| Organization Name: | BATON ROUGE CLINIC, A MEDICAL CORPORATION |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | C.E.O. |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | EDGAR |
| Authorized Official - Middle Name: | H |
| Authorized Official - Last Name: | SILVEY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 225-769-4044 |
| Mailing Address - Street 1: | 7373 PERKINS RD |
| Mailing Address - Street 2: | ATTENTION: ADMINISTRATION |
| Mailing Address - City: | BATON ROUGE |
| Mailing Address - State: | LA |
| Mailing Address - Zip Code: | 70808-4326 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 225-769-4044 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 7373 PERKINS RD |
| Practice Address - Street 2: | ATTENTION: ADMINISTRATION |
| Practice Address - City: | BATON ROUGE |
| Practice Address - State: | LA |
| Practice Address - Zip Code: | 70808-4326 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 225-769-4044 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-18 |
| Last Update Date: | 2024-08-14 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
| No | 207RS0012X | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | Group - Multi-Specialty |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2084N0402X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| LA | 1003310 | Medicaid |