Provider Demographics
NPI:1366498792
Name:OPELOUSAS CTA, LLC
Entity Type:Organization
Organization Name:OPELOUSAS CTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER GOVERNOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:KONUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-876-0300
Mailing Address - Street 1:PO BOX 4176
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-4176
Mailing Address - Country:US
Mailing Address - Phone:985-876-0300
Mailing Address - Fax:985-876-5529
Practice Address - Street 1:1233 WAYNE GILMORE CIRCLE, 5TH FLOOR
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6404
Practice Address - Country:US
Practice Address - Phone:337-407-3207
Practice Address - Fax:225-282-1049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory