Organization
LOUISIANA COLLEGE
Active
Other names
Louisiana College Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL PATRICK BERRY (BILLING SERVICE MANAGER)
(314) 598-1663
Entity
Organization
Contact information
Practice address
1140 COLLEGE DR, BOX 563, PINEVILLE, LA 71359-1000
(318) 487-7792
(318) 487-7174
Mailing address
1140 COLLEGE DR, PINEVILLE, LA 71359-3995
(318) 487-7792
(972) 367-3451
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
2255A2300X
Athletic Trainer
—
—
Other
Enumeration date
04/01/2014
Last updated
02/26/2021
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