Provider Demographics
NPI:1821540600
Name:MEDICAL CENTER OF LAFAYETTE LLC
Entity Type:Organization
Organization Name:MEDICAL CENTER OF LAFAYETTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LECKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-349-4686
Mailing Address - Street 1:204 PETROLEUM DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3880
Mailing Address - Country:US
Mailing Address - Phone:337-349-4686
Mailing Address - Fax:
Practice Address - Street 1:204 PETROLEUM DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3880
Practice Address - Country:US
Practice Address - Phone:337-349-4686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center