Healthcare Provider Details

I. General information

NPI: 1023748720
Provider Name (Legal Business Name): INSULINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 JOHNSTON ST
LAFAYETTE LA
70501-8059
US

IV. Provider business mailing address

220 JOHNSTON ST
LAFAYETTE LA
70501-8059
US

V. Phone/Fax

Practice location:
  • Phone: 337-254-9999
  • Fax: 337-522-7543
Mailing address:
  • Phone: 337-254-9999
  • Fax: 337-522-7543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAWN CALVIT
Title or Position: CEO
Credential: AUTHORIZED OFFICAL
Phone: 337-254-9999