Provider Demographics
NPI:1366401010
Name:PATRICK J. WELCH, M.D. (A PROFESSIONAL MEDICAL CORPORATION)
Entity type:Organization
Organization Name:PATRICK J. WELCH, M.D. (A PROFESSIONAL MEDICAL CORPORATION)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-289-6808
Mailing Address - Street 1:200 BEAULLIEU DRIVE, BUILDING 1
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7230
Mailing Address - Country:US
Mailing Address - Phone:337-289-6808
Mailing Address - Fax:337-289-6807
Practice Address - Street 1:200 BEAULLIEU DRIVE, BUILDING 1
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7230
Practice Address - Country:US
Practice Address - Phone:337-289-6808
Practice Address - Fax:337-289-6807
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATRICK J. WELCH, M.D. (A PROFESSIONAL MEDICAL CORPORATION)
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-21
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL12979R174400000X
LAMD.12979R207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1552704Medicaid
LAF20917Medicare UPIN