Southeast Spine Center, LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

SOUTHEAST SPINE CENTER, LLC

Practice address

17431 Jefferson Hwy
Suite a
Baton Rouge, LA 70817-7484

Phone

(225) 753-6333

Fax

(225) 753-6336

NPI assigned

Feb 14, 2012

Last updated

Feb 14, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. George J Ivanicky

Title

Owner/President

Phone

(225) 753-6333

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1329177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329177600000",
    "number": "1295008712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17431 JEFFERSON HWY",
            "address_2": "SUITE A",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708177484",
            "telephone_number": "225-753-6333",
            "fax_number": "225-753-6336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17431 JEFFERSON HWY",
            "address_2": "SUITE A",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708177484",
            "telephone_number": "225-753-6333",
            "fax_number": "225-753-6336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST SPINE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-14",
        "last_updated": "2012-02-14",
        "status": "A",
        "authorized_official_last_name": "IVANICKY",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "225-753-6333",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Regional Personal Care Service, LLC
• South Regional Personal Care Service, LLC
• Southeast Community Health Systems
• Southeast Community Health Systems
• Southeast Louisiana Veterans Health Care System
• Southeastern Cardiology Consultants
• Southeastern Cardiovascular Consultants-LLC
• Southeastern Cardiovascular Lab Services
• Southern Care Providers Inc
• Southern Care Providers Inc.

• Physical Medicine & Rehabilitation Physician in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Physical Medicine & Rehabilitation Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2012; 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.