Organization
TLC MOBILE MEDICAL OF LAFAYETTE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRENDA S LEBLANC (OWNER)
(281) 346-0801
Entity
Organization
Contact information
Practice address
110 HUGH WALLIS RD, LAFAYETTE, LA 70508-2107
(337) 289-5456
(337) 289-0119
Mailing address
PO BOX 80735, LAFAYETTE, LA 70598-0735
(281) 346-0801
(281) 346-0802
Taxonomy
Speciality
Code
Description
License number
State
261QR0208X
Mobile Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1373605
—
LA
01
—
39511
BLUE CROSS
LA
01
—
630000399
RAILROAD MEDICARE
LA
Enumeration date
03/15/2006
Last updated
01/02/2008
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