Organization
ORTHOPAEDIC CLINIC OF MONROE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN GOLDMAN CFO (ADMINISTRATOR)
(318) 362-4328
Entity
Organization
Contact information
Practice address
1500 COMMERCE ST, RUSTON, LA 71270-5845
(318) 323-8451
(318) 361-2613
Mailing address
1501 LOUISVILLE AVE, MONROE, LA 71201-6025
(318) 323-8451
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1004448
—
LA
Enumeration date
07/06/2017
Last updated
01/14/2022
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