Provider Demographics
NPI:1306021357
Name:LOUISIANA UROLOGY CENTER
Entity Type:Organization
Organization Name:LOUISIANA UROLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOREST
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:337-406-8009
Mailing Address - Street 1:5000 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:BLD 16
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6984
Mailing Address - Country:US
Mailing Address - Phone:337-406-8009
Mailing Address - Fax:337-406-8010
Practice Address - Street 1:5000 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:BLD 16
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6984
Practice Address - Country:US
Practice Address - Phone:337-406-8009
Practice Address - Fax:337-406-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11767R208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty