1427325364 NPI number — KENNETH L. ODINET MD, ASC-LLC

Table of content: (NPI 1427325364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427325364 NPI number — KENNETH L. ODINET MD, ASC-LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENNETH L. ODINET MD, ASC-LLC
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:
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:
1427325364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 BEAULLIEU DR
Provider Second Line Business Mailing Address:
BUILDING 6
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70508-7230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-234-8648
Provider Business Mailing Address Fax Number:
337-233-0244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 BEAULLIEU DR
Provider Second Line Business Practice Location Address:
BUILDING 6
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70508-7230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-234-8648
Provider Business Practice Location Address Fax Number:
337-233-0244
Provider Enumeration Date:
11/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ODINET
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
337-234-8648

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  177 , 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)





Copyright © 2007-2025 www.npivalidator.com