| L Glen Mire Md Inc | |
|
324 Dulles Dr Lafayette LA 70506-3008 | |
| (337) 981-0305 | |
| Not Available |
| Full Name | L Glen Mire Md Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 324 Dulles Dr, Lafayette, Louisiana |
| Authorized Official Name and Position | Louis Glen Mire (OWNER) |
| Authorized Official Contact | 3379810305 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| L Glen Mire Md Inc Po Box 61950 Lafayette LA 70596-1950 Ph: (337) 981-0305 | L Glen Mire Md Inc 324 Dulles Dr Lafayette LA 70506-3008 Ph: (337) 981-0305 |
| NPI Number | 1134328966 |
|---|---|
| Provider Enumeration Date | 07/12/2007 |
| Last Update Date | 05/21/2008 |
| Medicare PECOS PAC ID | 9739271560 |
|---|---|
| Medicare Enrollment ID | O20070823000763 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134328966 | NPI | - | NPPES |
| 1197386 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | 012202 (Louisiana) | Primary |
| Provider Name | Louis G Mire |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1366468084 PECOS PAC ID: 2365412814 Enrollment ID: I20070823000755 |
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