Provider Demographics
NPI:1407315617
Name:KP MEDICAL LLC
Entity Type:Organization
Organization Name:KP MEDICAL LLC
Other - Org Name:PREVAIL HEART CLINICS OF AMERICA-LAFAYETTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:SYLVESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-351-5510
Mailing Address - Street 1:854 KALISTE SALOOM RD STE C
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4367
Mailing Address - Country:US
Mailing Address - Phone:337-443-9063
Mailing Address - Fax:337-443-9067
Practice Address - Street 1:854 KALISTE SALOOM RD STE C
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4367
Practice Address - Country:US
Practice Address - Phone:337-443-9063
Practice Address - Fax:337-443-9063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty