Healthcare Provider Details

I. General information

NPI: 1073793519
Provider Name (Legal Business Name): LAFAYETTE HEALTH VENTURES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 HEYMANN BLVD
LAFAYETTE LA
70503-2616
US

IV. Provider business mailing address

PO BOX 53092
LAFAYETTE LA
70505-3092
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-6730
  • Fax: 337-237-9057
Mailing address:
  • Phone: 337-289-8974
  • Fax: 337-289-8961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD13115R
License Number StateLA

VIII. Authorized Official

Name: CAROLYN HUVAL
Title or Position: ADMINISTRATOR
Credential:
Phone: 337-289-8978