Provider Demographics
NPI:1730123555
Name:LAFAYETTE CATH LAB, LLC
Entity Type:Organization
Organization Name:LAFAYETTE CATH LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHLAIFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-428-2570
Mailing Address - Street 1:1116 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2119
Mailing Address - Country:US
Mailing Address - Phone:765-428-2570
Mailing Address - Fax:765-428-2580
Practice Address - Street 1:1116 N 16TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2119
Practice Address - Country:US
Practice Address - Phone:765-428-2570
Practice Address - Fax:765-428-2580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000198341OtherRAILROAD MEDICARE
IN179730Medicare ID - Type Unspecified