Provider Demographics
NPI:1437426384
Name:ON THE BOULEVARD WALK IN CLINIC
Entity Type:Organization
Organization Name:ON THE BOULEVARD WALK IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KALA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-988-9812
Mailing Address - Street 1:119 1/2 ARNOULD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6213
Mailing Address - Country:US
Mailing Address - Phone:337-988-9812
Mailing Address - Fax:337-988-9894
Practice Address - Street 1:119 1/2 ARNOULD BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6213
Practice Address - Country:US
Practice Address - Phone:337-988-9812
Practice Address - Fax:337-988-9894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty