1427287176 NPI number — LAFAYETTE HEALTH VENTURES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427287176 NPI number — LAFAYETTE HEALTH VENTURES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAFAYETTE HEALTH VENTURES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427287176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 62600
Provider Second Line Business Mailing Address:
DEPT 1721
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70162-2600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-706-1605
Provider Business Mailing Address Fax Number:
337-981-9257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1460 S COLLEGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70503-2912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-234-3344
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KIRK
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
337-289-8951

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  MD.203103 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1887129 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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