| Orthopaedic Reconstructive Sub-specialists LLC | |
|
1233 Wayne Gilmore Cir Suite 250-a Opelousas LA 70570-6405 | |
| (337) 948-8556 | |
| (337) 948-6881 |
| Full Name | Orthopaedic Reconstructive Sub-specialists LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 1233 Wayne Gilmore Cir, Opelousas, Louisiana |
| Authorized Official Name and Position | Paul E Fenn (OWNER / OPERATOR) |
| Authorized Official Contact | 3379488556 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Orthopaedic Reconstructive Sub-specialists LLC 1233 Wayne Gilmore Cir Suite 250-a Opelousas LA 70570-6405 Ph: (337) 948-8556 | Orthopaedic Reconstructive Sub-specialists LLC 1233 Wayne Gilmore Cir Suite 250-a Opelousas LA 70570-6405 Ph: (337) 948-8556 |
| NPI Number | 1255596490 |
|---|---|
| Provider Enumeration Date | 07/28/2008 |
| Last Update Date | 07/28/2008 |
| Medicare PECOS PAC ID | 7416024633 |
|---|---|
| Medicare Enrollment ID | O20080930000139 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255596490 | NPI | - | NPPES |
| 17200006687 | Other | LA | DR'S FENN'S NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 200825 (Louisiana) | Primary |
| Provider Name | Paul E Fenn |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1720006687 PECOS PAC ID: 2365473014 Enrollment ID: I20061018000107 |
| Provider Name | Shea Hare |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1215182142 PECOS PAC ID: 2961550157 Enrollment ID: I20090902000278 |
| Provider Name | Kathleen H Anthony |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1386078095 PECOS PAC ID: 2860627148 Enrollment ID: I20131022000564 |
| Provider Name | Melanie H Fitzmorris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285049015 PECOS PAC ID: 3274754296 Enrollment ID: I20141016000757 |
| Provider Name | Joey a Guillory |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1902209554 PECOS PAC ID: 9436472438 Enrollment ID: I20141224000479 |
| Provider Name | Courtney L Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467821629 PECOS PAC ID: 7618272873 Enrollment ID: I20160225001333 |
| Provider Name | Kayla a Bergeaux |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063076024 PECOS PAC ID: 6709115181 Enrollment ID: I20190910002821 |
| Provider Name | Christina N Chaisson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700416831 PECOS PAC ID: 2466882014 Enrollment ID: I20200422000732 |
| Provider Name | Rachel E Landrem |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225757040 PECOS PAC ID: 9436528296 Enrollment ID: I20221217000297 |
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