Organization Name: | LAFOURCHE MEDICAL GROUP LLC |
NPI Number: | 1164811790 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STEPHEN LIM (OWNER/PARTNER) |
Mailing Address: | 4912 Highway 1 Raceland |
State: | LA US |
Postal Code: | 703942559 |
Phone Number: | 9855322387 |
Fax Number: | 9855322388 |
NPI Enumeration Date: | 01/20/2015 |
NPI Last Update Date: | 08/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QU0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Urgent Care |
Taxonomy Definition: |