Healthcare Provider Details

I. General information

NPI: 1427507656
Provider Name (Legal Business Name): MSH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PATRIOT ST SUITE 101
LAFAYETTE LA
70508-6831
US

IV. Provider business mailing address

105 PATRIOT ST SUITE 101
LAFAYETTE LA
70508-6831
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-2125
  • Fax: 337-981-2174
Mailing address:
  • Phone: 337-981-2125
  • Fax: 337-981-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM A BRENNAN
Title or Position: MEMBER
Credential: M.D.
Phone: 337-981-2125