Organization
BAYOU ORTHOTIC AND PROSTHETIC CENTER LLC
Active
Parent organization
BAYOU ORTHOTIC AND PROSTHETIC CENTER LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BAYOU ORTHOTIC AND PROSTHETIC CENTER LLC
Authorized official
MR. KENNETH R. BORDELON C.P.O. (PARTNER/CEO)
(504) 341-1331
Entity
Organization
Contact information
Practice address
3717 VONNIE DR, HARVEY, LA 70058-2354
(504) 341-1331
(504) 341-1341
Mailing address
3717 VONNIE DR, HARVEY, LA 70058-2354
(504) 341-1331
(504) 341-1341
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011690
—
LA
01
—
G0464
BLUE CROSS BLUE SHIELD
LA
Enumeration date
08/14/2006
Last updated
03/17/2011
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