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General NPI Number Information
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NPI Number | 1366498792
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Entity Type | Organization
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Legal Business Name | OPELOUSAS CTA, LLC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1233 WAYNE GILMORE CIRCLE, 5TH FLOOR
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City | OPELOUSAS
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State | LA
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Zip | 70570-6404
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Country | US
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Telephone | 337-407-3207
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Fax | 225-282-1049
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Provider Business Mailing Address
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Address Line | PO BOX 4176
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City | HOUMA
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State | LA
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Zip | 70361-4176
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Country | US
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Telephone | 985-876-0300
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Fax | 985-876-5529
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Authorized Official
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Title or Position | MANAGER GOVERNOR
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Name | MR. DAVID C KONUR
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Credential |
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Telephone | 985-876-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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