Provider Demographics
NPI:1346475522
Name:HEART HOSPITAL OF ACADIANA, LLC
Entity Type:Organization
Organization Name:HEART HOSPITAL OF ACADIANA, LLC
Other - Org Name:HEART HOSPITAL OF LAFAYETTE COUMADIN SUITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WYBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-521-1000
Mailing Address - Street 1:1105 KALISTE SALOOM RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5705
Mailing Address - Country:US
Mailing Address - Phone:337-521-1000
Mailing Address - Fax:
Practice Address - Street 1:2621 NORTH DR RM 2
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4078
Practice Address - Country:US
Practice Address - Phone:337-893-3694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19026300Medicare Oscar/Certification