Healthcare Provider Details

I. General information

NPI: 1639179971
Provider Name (Legal Business Name): COL MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4906 AMBASSADOR CAFFERY PKWY BUILDING F
LAFAYETTE LA
70508-6916
US

IV. Provider business mailing address

4906 AMBASSADOR CAFFERY PKWY BUILDING F
LAFAYETTE LA
70508-6916
US

V. Phone/Fax

Practice location:
  • Phone: 337-291-9161
  • Fax: 337-289-0593
Mailing address:
  • Phone: 337-291-9161
  • Fax: 337-289-0593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES W. HOLMES
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 337-291-9161