Provider Demographics
NPI:1770213217
Name:BIOACTIVE INFUSION & WELLNESS, LLC
Entity Type:Organization
Organization Name:BIOACTIVE INFUSION & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GATTE
Authorized Official - Suffix:
Authorized Official - Credentials:FNPC
Authorized Official - Phone:337-581-7009
Mailing Address - Street 1:100 W LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578-5912
Mailing Address - Country:US
Mailing Address - Phone:337-581-7009
Mailing Address - Fax:
Practice Address - Street 1:100 W LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-5912
Practice Address - Country:US
Practice Address - Phone:337-581-7009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion TherapyGroup - Multi-Specialty