Provider Demographics
NPI:1457557977
Name:LAFAYETTE PEDIATRIC NEUROLOGY CENTER, LLC
Entity Type:Organization
Organization Name:LAFAYETTE PEDIATRIC NEUROLOGY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAGESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-988-7044
Mailing Address - Street 1:4650 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6926
Mailing Address - Country:US
Mailing Address - Phone:337-993-7391
Mailing Address - Fax:
Practice Address - Street 1:4650 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6926
Practice Address - Country:US
Practice Address - Phone:337-993-7391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HTI HOSPITAL HOLDINGS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-22
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5BD09Medicare PIN