Provider Demographics
NPI:1770775314
Name:LAWRENCE P MENACHE MD APMC
Entity type:Organization
Organization Name:LAWRENCE P MENACHE MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MENACHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-484-9749
Mailing Address - Street 1:PO BOX 13285
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-3285
Mailing Address - Country:US
Mailing Address - Phone:318-484-9749
Mailing Address - Fax:318-484-2505
Practice Address - Street 1:3330 MASONIC DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3841
Practice Address - Country:US
Practice Address - Phone:318-448-6917
Practice Address - Fax:318-484-2505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD08338R2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1901857Medicaid
LA1901857Medicaid