Provider Demographics
NPI:1114035946
Name:LAFAYETTE GENERAL ENDOSCOPY CENTER, INC.
Entity Type:Organization
Organization Name:LAFAYETTE GENERAL ENDOSCOPY CENTER, INC.
Other - Org Name:THE ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:P
Authorized Official - Last Name:TRAWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-735-7317
Mailing Address - Street 1:P.O. BOX 52328
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2328
Mailing Address - Country:US
Mailing Address - Phone:337-289-8249
Mailing Address - Fax:337-289-8246
Practice Address - Street 1:1211 COOLIDGE BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2636
Practice Address - Country:US
Practice Address - Phone:337-289-8249
Practice Address - Fax:337-289-8246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA166207L00000X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1907871Medicaid
LA1907871Medicaid