Provider Demographics
NPI:1528287760
Name:KIRK S LEBLANC MD LLC
Entity type:Organization
Organization Name:KIRK S LEBLANC MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-234-8533
Mailing Address - Street 1:1000 W PINHOOK RD STE 303
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2460
Mailing Address - Country:US
Mailing Address - Phone:337-234-8533
Mailing Address - Fax:337-234-8534
Practice Address - Street 1:1000 W PINHOOK RD STE 303
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2460
Practice Address - Country:US
Practice Address - Phone:337-234-8533
Practice Address - Fax:337-234-8534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09274R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1760474191OtherINDIVIDUAL NPI
LA1441805Medicaid
LA1668681Medicaid
LA5W493Medicare ID - Type UnspecifiedINIDIVIDUAL
LA1668681Medicaid
LA1441805Medicaid
LA5C925Medicare ID - Type UnspecifiedGROUP
LA4438530001Medicare NSC