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General NPI Number Information
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NPI Number | 1417986092
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Entity Type | Organization
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Legal Business Name | LAFAYETTE HEALTH VENTURES INC
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 04/15/2013
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Provider Practice Location Address
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Address Line | 1216 CAMELLIA BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70508-6667
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Country | US
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Telephone | 337-769-0069
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Fax | 337-769-0068
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Provider Business Mailing Address
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Address Line | 1216 CAMELLIA BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70508-6667
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Country | US
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Telephone | 337-769-0069
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Fax | 337-769-0068
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | BRIAN KIRK
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Credential |
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Telephone | 337-289-8951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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