Provider Demographics
NPI:1407904600
Name:DR K FOURNET ETALPTR
Entity Type:Organization
Organization Name:DR K FOURNET ETALPTR
Other - Org Name:CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:INSURANCE CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHAMPAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-394-5507
Mailing Address - Street 1:406 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARTINVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70582-4119
Mailing Address - Country:US
Mailing Address - Phone:337-394-5507
Mailing Address - Fax:337-394-5508
Practice Address - Street 1:406 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT MARTINVILLE
Practice Address - State:LA
Practice Address - Zip Code:70582-4119
Practice Address - Country:US
Practice Address - Phone:337-394-5507
Practice Address - Fax:337-394-5508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-07
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7061261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA50790Medicare ID - Type UnspecifiedPROVIDER #