Organization
ADVANCED SPORTS INJURY & SPINAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LISA G GODDARD (OFFICE MGR)
(337) 824-2901
Entity
Organization
Contact information
Practice address
1322 ELTON RD STE K, JENNINGS, LA 70546-4100
(337) 824-2901
Mailing address
1322 ELTON RD STE K, JENNINGS, LA 70546-4100
(337) 824-2901
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
1430
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1072770
—
LA
Enumeration date
08/21/2008
Last updated
09/25/2008
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