Healthcare Provider Details

I. General information

NPI: 1790705002
Provider Name (Legal Business Name): VO MEDICAL CLINIC A PROFESSIONAL MEDICAL CORPORATION
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

1017 W FERTITTA BLVD
LEESVILLE LA
71446-4646
US

IV. Provider business mailing address

1017 W FERTITTA BLVD
LEESVILLE LA
71446-4646
US

V. Phone/Fax

Practice location:
  • Phone: 337-239-2606
  • Fax: 337-238-5748
Mailing address:
  • Phone: 337-239-2606
  • Fax: 337-238-5748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LOI DAI VO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 337-239-2606