Healthcare Provider Details

I. General information

NPI: 1871627604
Provider Name (Legal Business Name): SJC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4551 JOHNSTON ST
LAFAYETTE LA
70503-4235
US

IV. Provider business mailing address

PO BOX 51738
LAFAYETTE LA
70505-1738
US

V. Phone/Fax

Practice location:
  • Phone: 337-984-0123
  • Fax: 337-984-5551
Mailing address:
  • Phone: 337-984-0123
  • Fax: 337-984-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateLA

VIII. Authorized Official

Name: MR. STEVEN J COURVILLE
Title or Position: MANAGER
Credential:
Phone: 337-984-0123