Ladebe LLC

Organization Active NPI Internal Medicine Physician · Lafayette, LA

NPI 1821216144 · NPPES record last updated May 10, 2012

Key facts

NPI
1821216144
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
LADEBE LLC
Practice address
804 Richland Ave
Lafayette, LA 70508-6661
Phone
(337) 291-2455
NPI assigned
Apr 23, 2007
Organization subpart
No

Authorized official

Name
Dr. Federico Deltoro, M.D.
Title
Physician
Phone
(337) 288-5557

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in LA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20120516000180 LA Part B Supplier - Clinic/Group Practice 9335302017 Receives reassigned benefits from 2 practitioners
Practice locations: Lafayette, LA

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP
207R00000X Yes
Nephrology Physician
Group: 193200000X MULTI-SPECIALTY GROUP
207RN0300X

Addresses

Primary practice location

804 Richland Ave
Lafayette, LA 70508-6661

Mailing address

PO Box 81736
Lafayette, LA 70598-1736
Phone (337) 291-2455

Other identifiers

IdentifierTypeStateIssuer
1444855MedicaidLA

Other providers in Lafayette, LA

All providers in Lafayette, LA · Internal Medicine Physician in Louisiana

Sources for this page

Verify at the official NPI Registry.