Provider Demographics
NPI:1437208840
Name:ALLERGY ASTHMA & IMMUNOLOGY CENTER OF SOUTHWEST LOUISIANA
Entity Type:Organization
Organization Name:ALLERGY ASTHMA & IMMUNOLOGY CENTER OF SOUTHWEST LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-981-9495
Mailing Address - Street 1:320 SETTLERS TRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6060
Mailing Address - Country:US
Mailing Address - Phone:337-981-9495
Mailing Address - Fax:337-981-7451
Practice Address - Street 1:320 SETTLERS TRACE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-981-9495
Practice Address - Fax:337-981-7451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1443115Medicaid
LA1443115Medicaid