NPIMap

Organization Active NPI

Bayou Wellness Center, Inc.

  • Sports Medicine (Family Medicine) Physician
  • Lacombe, LA
National Provider Identifier
1083854087
Registry record updated Apr 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
Legal business name
BAYOU WELLNESS CENTER, INC.
Practice address
27403 Hwy 190, Suite B
Lacombe, LA 70445-1550
Phone
(985) 218-9555
Fax
(985) 218-9557
NPI assigned
Mar 3, 2009
Organization subpart
Yes
Parent organization
BAYOU WELLNESS CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 2, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miss Linda Marie Anderson
Title
Ceo/Owner
Phone
(985) 218-9556

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X LA Primary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X LA
Preventive Medicine/Occupational Environmental Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0500X LA
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X

Addresses

Primary practice location

27403 Hwy 190, Suite B
Lacombe, LA 70445-1550

Mailing address

PO Box 1550
27403 Hwy 190, Suite B
Lacombe, LA 70445-1550
Phone (985) 218-9555

Other identifiers 2

IdentifierTypeStateIssuer
21-33306MedicaidLA
2133306MedicaidLA

National Provider Directory

National Provider Directory
Part of
Bayou Wellness Center Inc

Locations

27403 Highway 190
#B
Lacombe, LA 70445
Phone (985) 218-9555

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1236038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396396800000",
    "number": "1083854087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1550",
            "address_2": "27403 HWY 190, SUITE B",
            "city": "LACOMBE",
            "state": "LA",
            "postal_code": "704451550",
            "telephone_number": "985-218-9555",
            "fax_number": "985-218-9557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27403 HWY 190, SUITE B",
            "city": "LACOMBE",
            "state": "LA",
            "postal_code": "704451550",
            "telephone_number": "985-218-9555",
            "fax_number": "985-218-9557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYOU WELLNESS CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAYOU WELLNESS CENTER, INC.",
        "enumeration_date": "2009-03-03",
        "last_updated": "2014-04-02",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "985-218-9556",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": "LA",
            "license": null,
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "LA",
            "license": null,
            "primary": false
        },
        {
            "code": "2083P0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": "LA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21-33306",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2133306",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lacombe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.