Healthcare Provider Details

I. General information

NPI: 1013134147
Provider Name (Legal Business Name): KIDNEY TREATMENT OPTIONS CENTER OF LAFAYETTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 E PRUDHOMME ST
OPELOUSAS LA
70570-8240
US

IV. Provider business mailing address

927 E PRUDHOMME ST
OPELOUSAS LA
70570-8240
US

V. Phone/Fax

Practice location:
  • Phone: 337-594-8535
  • Fax: 337-594-8534
Mailing address:
  • Phone: 337-594-8535
  • Fax: 337-594-8534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES E ATTRILL JR.
Title or Position: PRESIDENT, MEMBER
Credential:
Phone: 615-327-3061