Cityblock Medical Practice la, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

CITYBLOCK MEDICAL PRACTICE LA, LLC

Practice address

1042 Camellia Blvd
Lafayette, LA 70508-6680

Phone

(800) 336-1100

NPI assigned

Oct 11, 2021

Last updated

Oct 11, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Devon Minerve

Title

Corporate Counsel

Phone

(202) 321-2528

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633910400000",
    "number": "1790447373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 FLATBUSH AVE STE C5",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112253706",
            "telephone_number": "800-336-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1042 CAMELLIA BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705086680",
            "telephone_number": "800-336-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITYBLOCK MEDICAL PRACTICE LA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-11",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-07",
        "status": "A",
        "authorized_official_last_name": "MINERVE",
        "authorized_official_first_name": "DEVON",
        "authorized_official_title_or_position": "CORPORATE COUNSEL",
        "authorized_official_telephone_number": "202-321-2528"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Lafayette, LA
• Providers in Lafayette, LA by specialty
• General Practice Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.