Provider Demographics
NPI:1477748861
Name:LAFAYETTE CHILDRENS CLINIC LLC
Entity type:Organization
Organization Name:LAFAYETTE CHILDRENS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:COREIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-593-8888
Mailing Address - Street 1:5000 AMBASSADOR CAFFERY PKWY.
Mailing Address - Street 2:# 12
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-593-8888
Mailing Address - Fax:
Practice Address - Street 1:5000 AMBASSADOR CAFFERY PKWY.
Practice Address - Street 2:# 12
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-593-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12562R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty