Provider Demographics
NPI:1104014349
Name:LOUISIANA KIDNEY UPDATE, LLC
Entity type:Organization
Organization Name:LOUISIANA KIDNEY UPDATE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:P
Authorized Official - Last Name:BLALOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-257-4918
Mailing Address - Street 1:523 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3113
Mailing Address - Country:US
Mailing Address - Phone:337-234-5541
Mailing Address - Fax:337-593-8330
Practice Address - Street 1:4811 AMBASSADOR CAFFERY PKWY FL 4
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7265
Practice Address - Country:US
Practice Address - Phone:337-839-9880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty