Provider Demographics
NPI:1275299489
Name:LAFAYETTE INTEGRATIVE MEDICINE LLC
Entity Type:Organization
Organization Name:LAFAYETTE INTEGRATIVE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-580-3005
Mailing Address - Street 1:4212 W CONGRESS ST STE 2400B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6768
Mailing Address - Country:US
Mailing Address - Phone:337-703-3330
Mailing Address - Fax:337-703-3331
Practice Address - Street 1:4212 W CONGRESS ST STE 2400B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6768
Practice Address - Country:US
Practice Address - Phone:337-703-3330
Practice Address - Fax:337-703-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty