Provider Demographics
NPI:1346652161
Name:JAY LUKE LLC
Entity Type:Organization
Organization Name:JAY LUKE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:LUKE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:337-289-9702
Mailing Address - Street 1:155 HOSPITAL DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2852
Mailing Address - Country:US
Mailing Address - Phone:337-289-9700
Mailing Address - Fax:337-289-9702
Practice Address - Street 1:155 HOSPITAL DR
Practice Address - Street 2:STE 410
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2852
Practice Address - Country:US
Practice Address - Phone:337-289-9700
Practice Address - Fax:337-289-9702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1000850Medicaid