Healthcare Provider Details

I. General information

NPI: 1891940912
Provider Name (Legal Business Name): LAFAYETTE HEALTH VENTURES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 COOLIDGE BLVD
LAFAYETTE LA
70503-2621
US

IV. Provider business mailing address

PO BOX 53092
LAFAYETTE LA
70505-3092
US

V. Phone/Fax

Practice location:
  • Phone: 337-289-8978
  • Fax:
Mailing address:
  • Phone: 337-289-8978
  • Fax: 337-289-8970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN HUVAL
Title or Position: VICE PRESIDENT
Credential:
Phone: 337-289-8959