Provider Demographics
NPI:1508810649
Name:LAFAYETTE HEALTH VENTURES. INC
Entity Type:Organization
Organization Name:LAFAYETTE HEALTH VENTURES. INC
Other - Org Name:OB-GYN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:VICE PRESIDENT
Authorized Official - Phone:338-289-8951
Mailing Address - Street 1:PO BOX 53092
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-3092
Mailing Address - Country:US
Mailing Address - Phone:338-289-8976
Mailing Address - Fax:337-289-8970
Practice Address - Street 1:1211 COOLIDGE BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2636
Practice Address - Country:US
Practice Address - Phone:337-289-8440
Practice Address - Fax:337-289-8442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1712426Medicaid
LACG2600OtherRAILROAD MEDICARE
LACG2600OtherRAILROAD MEDICARE