Provider Demographics
NPI:1720423478
Name:LAFAYETTE CARDIOVASCULAR CENTER OF EXCELLENCE,LLC
Entity Type:Organization
Organization Name:LAFAYETTE CARDIOVASCULAR CENTER OF EXCELLENCE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:337-274-6549
Mailing Address - Street 1:901 WILSON ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2439
Mailing Address - Country:US
Mailing Address - Phone:337-534-4614
Mailing Address - Fax:
Practice Address - Street 1:901 WILSON ST STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2439
Practice Address - Country:US
Practice Address - Phone:337-534-4614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty