Provider Demographics
NPI:1477506210
Name:DR ANDRE L PINAC III LLC
Entity Type:Organization
Organization Name:DR ANDRE L PINAC III LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PINAC
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:337-942-2112
Mailing Address - Street 1:816 CRESWELL LANE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570
Mailing Address - Country:US
Mailing Address - Phone:337-942-2112
Mailing Address - Fax:337-942-5805
Practice Address - Street 1:816 CRESWELL LANE
Practice Address - Street 2:SUITE 1
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570
Practice Address - Country:US
Practice Address - Phone:337-942-2112
Practice Address - Fax:337-942-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016264207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1348830Medicaid
B63575Medicare UPIN
5CU80Medicare PIN