Provider Demographics
NPI:1104172154
Name:LOUISIANA OCCUPATIONAL MEDICINE AND SAFETY INSTITUTE
Entity type:Organization
Organization Name:LOUISIANA OCCUPATIONAL MEDICINE AND SAFETY INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:IEYOUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-475-8196
Mailing Address - Street 1:2492 S CITIES SERVICE HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70665-6497
Mailing Address - Country:US
Mailing Address - Phone:337-475-8195
Mailing Address - Fax:
Practice Address - Street 1:2492 S CITIES SERVICE HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70665-6497
Practice Address - Country:US
Practice Address - Phone:337-475-8195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine