Provider Demographics
NPI:1215380506
Name:PREMIER PEDIATRICS OF ACADIANA, LLC
Entity Type:Organization
Organization Name:PREMIER PEDIATRICS OF ACADIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-635-6943
Mailing Address - Street 1:118 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2819
Mailing Address - Country:US
Mailing Address - Phone:337-237-1252
Mailing Address - Fax:985-635-6948
Practice Address - Street 1:1512 CHEMIN METAIRIE RD
Practice Address - Street 2:SUITE B
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5382
Practice Address - Country:US
Practice Address - Phone:337-237-1252
Practice Address - Fax:985-635-6948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.205011208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty