{
"Npi": {
"NPI": "1699447243",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "LAFAYETTE HEALTH VENTURES, INC",
"ParentOrgTIN": null,
"OrgName": "LAFAYETTE HEALTH VENTURES, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 919229",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DALLAS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75391-9229",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "337-289-8944",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1122 SOUTH BERNARD",
"SecondLinePracticeLocationAddress": "SUITE C",
"PracticeLocationAddressCityName": "BROUSSARD",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "70518-3408",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "337-703-6476",
"PracticeLocationAddressFaxNumber": "337-703-6477",
"EnumerationDate": "10/01/2021",
"LastUpdateDate": "10/19/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DOOLEY",
"AuthorizedOfficialFirstName": "KIM",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "VP",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "337-571-1394",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}