Provider Demographics
NPI:1427156629
Name:WALTER A. RAMKE, JR.
Entity type:Organization
Organization Name:WALTER A. RAMKE, JR.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:RAMKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:RT
Authorized Official - Phone:337-893-3385
Mailing Address - Street 1:704 COBBLESTONE ROAD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4958
Mailing Address - Country:US
Mailing Address - Phone:337-893-3385
Mailing Address - Fax:337-205-5970
Practice Address - Street 1:704 COBBLESTONE ROAD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4958
Practice Address - Country:US
Practice Address - Phone:337-893-3385
Practice Address - Fax:337-205-5970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA510174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1626317Medicaid
LA1626317Medicaid