Provider Demographics
NPI:1114315330
Name:LAFAYETTE GENERAL MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:LAFAYETTE GENERAL MEDICAL CENTER, INC.
Other - Org Name:LAFAYETTE GENERAL PINHOOK PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT, EVP
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALLECOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-289-7610
Mailing Address - Street 1:1214 COOLIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2621
Mailing Address - Country:US
Mailing Address - Phone:337-289-7991
Mailing Address - Fax:
Practice Address - Street 1:1214 COOLIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2621
Practice Address - Country:US
Practice Address - Phone:337-289-7991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAFAYETTE GENERAL HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA70013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy