I D Medical Associates LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

15601R Issued in LA

Legal business name

I D MEDICAL ASSOCIATES LLC

Practice address

1119 Prudhomme Cir
Opelousas, LA 70570-6544

Phone

(337) 407-1955

Fax

(337) 407-1956

NPI assigned

Jul 23, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Vitalis C Okechukwu, MD

Title

Owner Operator

Phone

(337) 407-1955

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962423848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1119 PRUDHOMME CIR",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "705706544",
            "telephone_number": "337-407-1955",
            "fax_number": "337-407-1956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 PRUDHOMME CIR",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "705706544",
            "telephone_number": "337-407-1955",
            "fax_number": "337-407-1956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "I D MEDICAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OKECHUKWU",
        "authorized_official_first_name": "VITALIS",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER OPERATOR",
        "authorized_official_telephone_number": "337-407-1955",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "LA",
            "license": "15601R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1 07409 8",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Opelousas, LA
• Providers in Opelousas, LA by specialty
• Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.