Healthcare Provider Details

I. General information

NPI: 1366498792
Provider Name (Legal Business Name): OPELOUSAS CTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 WAYNE GILMORE CIRCLE, 5TH FLOOR
OPELOUSAS LA
70570-6404
US

IV. Provider business mailing address

PO BOX 4176
HOUMA LA
70361-4176
US

V. Phone/Fax

Practice location:
  • Phone: 337-407-3207
  • Fax: 225-282-1049
Mailing address:
  • Phone: 985-876-0300
  • Fax: 985-876-5529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID C KONUR
Title or Position: MANAGER GOVERNOR
Credential:
Phone: 985-876-0300