Healthcare Provider Details

I. General information

NPI: 1700472842
Provider Name (Legal Business Name): OPIOID ADDICTION SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 12/14/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 COULEE SHORE DR
LAFAYETTE LA
70503-3021
US

IV. Provider business mailing address

102 COULEE SHORE DR
LAFAYETTE LA
70503-3021
US

V. Phone/Fax

Practice location:
  • Phone: 337-789-0558
  • Fax: 337-326-5915
Mailing address:
  • Phone: 337-789-0558
  • Fax: 337-326-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN PHILIP SOMNER JR.
Title or Position: MEMBER
Credential: MD
Phone: 646-279-6493