Provider Demographics
NPI:1902822786
Name:LAFAYETTE HEART HOSPITAL LLC
Entity Type:Organization
Organization Name:LAFAYETTE HEART HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR BUSINESS OFFICE OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:FENTEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-702-7500
Mailing Address - Street 1:1105 KALISTE SALOOM RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TX
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-521-1000
Mailing Address - Fax:
Practice Address - Street 1:1105 KALISTE SALOOM RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5705
Practice Address - Country:US
Practice Address - Phone:337-521-1017
Practice Address - Fax:337-521-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA393491282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA60709OtherBLUE CROSS
LA1703095Medicaid
LA1703095Medicaid