Provider Demographics
NPI:1861554115
Name:TRENT FOGLEMAN, M.D., LLC
Entity type:Organization
Organization Name:TRENT FOGLEMAN, M.D., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADDIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:LAVIOLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:337-456-7790
Mailing Address - Street 1:1817 BERTRAND DR.
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506
Mailing Address - Country:US
Mailing Address - Phone:337-456-7790
Mailing Address - Fax:337-443-9220
Practice Address - Street 1:1817 BERTRAND DR.
Practice Address - Street 2:SUITE D
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506
Practice Address - Country:US
Practice Address - Phone:337-456-7790
Practice Address - Fax:337-443-9220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1016179Medicaid
LA193878Medicare Oscar/Certification