Healthcare Provider Details

I. General information

NPI: 1427287176
Provider Name (Legal Business Name): LAFAYETTE HEALTH VENTURES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 S COLLEGE RD
LAFAYETTE LA
70503-2912
US

IV. Provider business mailing address

PO BOX 62600 DEPT 1721
NEW ORLEANS LA
70162-2600
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-3344
  • Fax:
Mailing address:
  • Phone: 337-706-1605
  • Fax: 337-981-9257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD.203103
License Number StateLA

VIII. Authorized Official

Name: BRIAN KIRK
Title or Position: VICE PRESIDENT
Credential:
Phone: 337-289-8951