Provider Demographics
NPI:1013134147
Name:KIDNEY TREATMENT OPTIONS CENTER OF LAFAYETTE LLC
Entity Type:Organization
Organization Name:KIDNEY TREATMENT OPTIONS CENTER OF LAFAYETTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:ATTRILL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:615-327-3061
Mailing Address - Street 1:927 E PRUDHOMME ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-8240
Mailing Address - Country:US
Mailing Address - Phone:337-594-8535
Mailing Address - Fax:337-594-8534
Practice Address - Street 1:927 E PRUDHOMME ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-8240
Practice Address - Country:US
Practice Address - Phone:337-594-8535
Practice Address - Fax:337-594-8534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CX77Medicare PIN