Provider Demographics
NPI:1760996706
Name:OCCUPATIONAL MEDICINE CLINICS OF SOUTH LOUISIANA
Entity Type:Organization
Organization Name:OCCUPATIONAL MEDICINE CLINICS OF SOUTH LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-4480
Mailing Address - Street 1:314 YOUNGSVILLE HWY STE 1A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4524
Mailing Address - Country:US
Mailing Address - Phone:337-233-4480
Mailing Address - Fax:337-769-1458
Practice Address - Street 1:314 YOUNGSVILLE HWY STE 1A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4524
Practice Address - Country:US
Practice Address - Phone:337-233-4480
Practice Address - Fax:337-769-1458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care