MEDICARE: LAFAYETTE HEALTH VENTURES. INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CG2600	OTHER	LA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508810649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAFAYETTE HEALTH VENTURES. INC

Provider Business Mailing Address
First Line	:	PO BOX 53092
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70505-3092
Country	:	US
Telephone Number	:	338-289-8976
Fax Number	:	337-289-8970

Provider Business Practice Location Address
First Line	:	1211 COOLIDGE BLVD
Second Line	:	SUITE 404
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-2636
Country	:	US
Telephone Number	:	337-289-8440
Fax Number	:	337-289-8442

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	BRIAN KIRK
Credential	:	VICE PRESIDENT
Telephone Number	:	338-289-8951

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	10/26/2011

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Directions to “LAFAYETTE HEALTH VENTURES. INC ” Practice Location

Language	Start Address	Practice Location

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