Provider Demographics
NPI:1790272490
Name:NEUROMEND INFUSION CENTER, LLC
Entity Type:Organization
Organization Name:NEUROMEND INFUSION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-347-6655
Mailing Address - Street 1:4906 AMBASSADOR CAFFERY PKWY BLDG B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6962
Mailing Address - Country:US
Mailing Address - Phone:337-347-6655
Mailing Address - Fax:337-347-6498
Practice Address - Street 1:4906 AMBASSADOR CAFFERY PKWY BLDG B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6962
Practice Address - Country:US
Practice Address - Phone:337-347-6655
Practice Address - Fax:337-347-6498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy