Organization
BAYOU STATE GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKIE VAUGHN (OFFICE MANAGER)
(337) 546-0101
Entity
Organization
Contact information
Practice address
1021 E LAUREL STREET, EUNICE, LA 70535
(337) 546-0101
(337) 546-0071
Mailing address
PO BOX 65208, BATON ROUGE, LA 70896
(337) 546-0101
(337) 546-0071
Taxonomy
Speciality
Code
Description
License number
State
2251N0400X
Neurology Physical Therapist
Primary
021809
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1448753
—
LA
Enumeration date
09/06/2006
Last updated
08/22/2020
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