Organization Name: | LAFOURCHE MEDICAL GROUP LLC |
NPI Number: | 1750749263 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STEPHEN LIM (OWNER) |
Mailing Address: | 13100 River Rd Suite 100 Destrehan |
State: | LA US |
Postal Code: | 700475203 |
Phone Number: | 9852350010 |
Fax Number: | |
NPI Enumeration Date: | 01/29/2016 |
NPI Last Update Date: | 01/29/2016 |
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: |