Provider Demographics
NPI:1992773949
Name:ZACHARY ORTHOPAEDIC CARE CENTER
Entity type:Organization
Organization Name:ZACHARY ORTHOPAEDIC CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-658-9996
Mailing Address - Street 1:PO BOX 975
Mailing Address - Street 2:ZACHARY ORTOPAEDIC CARE CENTER
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791
Mailing Address - Country:US
Mailing Address - Phone:225-658-9996
Mailing Address - Fax:225-658-9970
Practice Address - Street 1:4845 MAIN ST
Practice Address - Street 2:SUITE B-1
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-3943
Practice Address - Country:US
Practice Address - Phone:225-658-9996
Practice Address - Fax:225-658-9970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2964486970OtherBCBS
LA1069124Medicaid
LA5CN87Medicare ID - Type Unspecified
LA1069124Medicaid
LA2964486970OtherBCBS
C75426Medicare UPIN