Provider Demographics
NPI:1164805719
Name:LAFAYETTE HEALTH VENTURES, INC.
Entity Type:Organization
Organization Name:LAFAYETTE HEALTH VENTURES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-289-8941
Mailing Address - Street 1:900 E ST MARY STREET
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2378
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 E SAINT MARY BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2377
Practice Address - Country:US
Practice Address - Phone:337-289-8864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206805208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty