Provider Demographics
NPI:1245407931
Name:DR CONCEPCION & ASSOCIATES THERAPEUTIC CTR
Entity Type:Organization
Organization Name:DR CONCEPCION & ASSOCIATES THERAPEUTIC CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIOLETA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONCEPCION
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:337-981-1400
Mailing Address - Street 1:1131 RUE DU BELIER
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6532
Mailing Address - Country:US
Mailing Address - Phone:337-981-1400
Mailing Address - Fax:337-981-6611
Practice Address - Street 1:1131 RUE DU BELIER
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6532
Practice Address - Country:US
Practice Address - Phone:337-981-1400
Practice Address - Fax:337-981-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11294R261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
2084P0800XOtherTAXONOMY
LA11294ROtherSTATE LICENSE
LA1664448Medicaid
2084P0800XOtherTAXONOMY
LAG15806Medicare UPIN