Healthcare Provider Details

I. General information

NPI: 1063432524
Provider Name (Legal Business Name): O E REAVILL M D, APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W PINHOOK RD
LAFAYETTE LA
70508-3346
US

IV. Provider business mailing address

2501 W PINHOOK RD
LAFAYETTE LA
70508-3346
US

V. Phone/Fax

Practice location:
  • Phone: 337-264-1000
  • Fax: 337-264-7830
Mailing address:
  • Phone: 337-264-1000
  • Fax: 337-264-7830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number07184R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number07184R
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number07184R
License Number StateLA

VIII. Authorized Official

Name: DR. OLGA E REAVILL
Title or Position: OWNER
Credential: M D
Phone: 337-264-1000