Provider Demographics
NPI:1083834352
Name:ACADIANA VASCULAR CENTER, LLC
Entity Type:Organization
Organization Name:ACADIANA VASCULAR CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAGRAIZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-289-9700
Mailing Address - Street 1:129 RUE LOUIS XIV
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5738
Mailing Address - Country:US
Mailing Address - Phone:337-289-9700
Mailing Address - Fax:337-289-9702
Practice Address - Street 1:129 RUE LOUIS XIV
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5738
Practice Address - Country:US
Practice Address - Phone:337-289-9700
Practice Address - Fax:337-289-9702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1445819Medicaid
LA435889460AOtherBLUE CROSS
LA5CH18OtherMEDICARE PTAN
LA14474ROtherMEDICAL LICENSE
LAH62476Medicare UPIN