Provider Demographics
NPI:1194841098
Name:LAHASKY MEDICAL CLINIC APMC
Entity Type:Organization
Organization Name:LAHASKY MEDICAL CLINIC APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MYRON
Authorized Official - Last Name:LAHASKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-898-1860
Mailing Address - Street 1:2621 NORTH DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-4042
Mailing Address - Country:US
Mailing Address - Phone:337-898-1860
Mailing Address - Fax:337-898-1862
Practice Address - Street 1:2621 NORTH DR
Practice Address - Street 2:SUITE B
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4042
Practice Address - Country:US
Practice Address - Phone:337-898-1860
Practice Address - Fax:337-898-1862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1109401Medicaid
LA5CX68Medicare PIN