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General NPI Number Information
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NPI Number | 1104014349
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Entity Type | Organization
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Legal Business Name | LOUISIANA KIDNEY UPDATE, LLC
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 4811 AMBASSADOR CAFFERY PKWY FL 4
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City | LAFAYETTE
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State | LA
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Zip | 70508-7265
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Country | US
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Telephone | 337-839-9880
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Fax |
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Provider Business Mailing Address
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Address Line | 523 BEVERLY DR
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City | LAFAYETTE
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State | LA
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Zip | 70503-3113
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Country | US
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Telephone | 337-234-5541
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Fax | 337-593-8330
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Authorized Official
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Title or Position | PARTNER/PHYSICIAN
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Name | ANTHONY P BLALOCK
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Credential | M.D.
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Telephone | 337-257-4918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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