Provider Demographics
NPI:1336299056
Name:KENNETH D FUTCH, MD, AMC
Entity Type:Organization
Organization Name:KENNETH D FUTCH, MD, AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:FUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-269-9777
Mailing Address - Street 1:PO BOX 52507
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2507
Mailing Address - Country:US
Mailing Address - Phone:337-269-9777
Mailing Address - Fax:
Practice Address - Street 1:155 HOSPITAL DR
Practice Address - Street 2:STE 101
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2852
Practice Address - Country:US
Practice Address - Phone:337-269-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010958207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB60420Medicare UPIN