NPI 1306083894

Ibl Special Care Management Services

Organisation Exclusive Provider Organization Baton Rouge, LA

Practice location

Address: 11616 Southfork Ave STE 204, Baton Rouge, LA 70816-5241
Phone: (225) 291-3123
Fax: (225) 291-3069
Mailing address: 14241 Coursey Blvd STE A12167, Baton Rouge, LA 70817-1368

Authorised official

Name: Samantha Ann Roach
Title: Administrator
Phone: (225) 291-3123

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence PCA 15172 (LA)

Other Exclusive Provider Organization providers in Louisiana →

Registry record

NPI: 1306083894
Entity type: Organization
NPI issued: 21 Jan 2009
Record last updated: 4 Feb 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.