1649408832 NPI number — LAFAYETTE GENERAL MEDICAL CENTER 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 1649408832 NPI number — LAFAYETTE GENERAL MEDICAL CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAFAYETTE GENERAL MEDICAL CENTER 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:
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:
1649408832
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1214 COOLIDGE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70503-2621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-289-8978
Provider Business Mailing Address Fax Number:
337-289-8970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1214 COOLIDGE BLVD
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:
70503-2621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-289-8978
Provider Business Practice Location Address Fax Number:
337-289-8970
Provider Enumeration Date:
06/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MATTKE
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
337-289-8678

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1816451 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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