Provider Demographics
NPI:1376723627
Name:ENDURANCE IYAMU
Entity type:Organization
Organization Name:ENDURANCE IYAMU
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ENDURANCE
Authorized Official - Middle Name:I
Authorized Official - Last Name:IYAMU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-232-6601
Mailing Address - Street 1:920 W PINHOOK RD STE 339302
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2455
Mailing Address - Country:US
Mailing Address - Phone:337-232-6601
Mailing Address - Fax:
Practice Address - Street 1:920 W.PINHOOK RD STE. 339/302
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2455
Practice Address - Country:US
Practice Address - Phone:337-232-6601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-04
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6047750001Medicare NSC