Organization
MAYFAIR PHYSICIAN SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISHA C FALK (VP OF CONTRACTING)
(337) 609-1221
Entity
Organization
Contact information
Practice address
17000 MEDICAL CENTER DR, BATON ROUGE, LA 70816-3246
(225) 752-2470
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
208M00000X
Hospitalist Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LC0200X
Critical Care Medicine Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2475801
—
LA
Enumeration date
05/10/2018
Last updated
11/04/2022
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