Provider Demographics
NPI:1023638715
Name:LAFAYETTE GENERAL MEDICAL CENTER INC.
Entity type:Organization
Organization Name:LAFAYETTE GENERAL MEDICAL CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:GANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-289-7743
Mailing Address - Street 1:PO BOX 54287
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70154-4287
Mailing Address - Country:US
Mailing Address - Phone:337-289-8812
Mailing Address - Fax:337-289-8813
Practice Address - Street 1:1214 COOLIDGE BLVD FL 1
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2621
Practice Address - Country:US
Practice Address - Phone:337-289-8812
Practice Address - Fax:337-289-8813
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAFAYETTE GENERAL MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-22
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2207857Medicaid