Provider Demographics
NPI:1639100704
Name:LAFAYETTE HEALTH VENTURES INC.
Entity Type:Organization
Organization Name:LAFAYETTE HEALTH VENTURES INC.
Other - Org Name:ADVANCED MEDICAL SUPPLIES & SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-289-7138
Mailing Address - Street 1:1010 COOLIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2436
Mailing Address - Country:US
Mailing Address - Phone:337-289-8929
Mailing Address - Fax:337-289-8928
Practice Address - Street 1:1010 COOLIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2436
Practice Address - Country:US
Practice Address - Phone:337-289-8929
Practice Address - Fax:337-289-8928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1660141Medicaid
LA1019650001Medicare ID - Type Unspecified