Organization · NPI-2

I D Medical Associates LLC

Clinic/Center · Opelousas, LA

NPI number1962423848
StatusActive
Last updated in NPPESAug 22, 2020

Details

NPI
1962423848
Entity type
Organization (NPI-2)
Legal business name
I D Medical Associates LLC
Organization subpart
No
Enumeration date
Jul 23, 2006
Last updated
Aug 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center15601RLAYes

Practice location

1119 Prudhomme Cir
Opelousas, LA 70570-6544

Phone 337-407-1955 · Fax 337-407-1956

Mailing address

1119 Prudhomme Cir
Opelousas, LA 70570-6544

Phone 337-407-1955 · Fax 337-407-1956

Authorized official

Vitalis C Okechukwu
Owner Operator
3374071955

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