Southern Spine & Orthopaedics LLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

SOUTHERN SPINE & ORTHOPAEDICS LLC

Practice address

105 Patriot St Ste 101
Lafayette, LA 70508-6831

Phone

(337) 981-2125

Fax

(337) 981-2174

NPI assigned

Sep 16, 2024

Organization subpart

No

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

Authorized official

Name

Kathryn Clark

Title

Credentialing

Phone

(337) 706-1142

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Julio Petilon, M.D.

  • Orthopaedic Surgery Physician
  • Lafayette, LA
  • NPI 1245205020
  Medicare reassignment NPD

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

{
    "created_epoch": "1726444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726444800000",
    "number": "1255168175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 PATRIOT ST STE 101",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705086831",
            "telephone_number": "337-981-2125",
            "fax_number": "337-981-2174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 PATRIOT ST STE 101",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705086831",
            "telephone_number": "337-981-2125",
            "fax_number": "337-981-2174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN SPINE & ORTHOPAEDICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-16",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "337-706-1142"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthopaedic Surgery Physician in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Orthopaedic Surgery Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.