Provider Demographics
NPI:1427325364
Name:KENNETH L. ODINET MD, ASC-LLC
Entity type:Organization
Organization Name:KENNETH L. ODINET MD, ASC-LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:ODINET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-234-8648
Mailing Address - Street 1:200 BEAULLIEU DR
Mailing Address - Street 2:BUILDING 6
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7230
Mailing Address - Country:US
Mailing Address - Phone:337-234-8648
Mailing Address - Fax:337-233-0244
Practice Address - Street 1:200 BEAULLIEU DR
Practice Address - Street 2:BUILDING 6
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7230
Practice Address - Country:US
Practice Address - Phone:337-234-8648
Practice Address - Fax:337-233-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA177261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical