Provider Demographics
NPI:1790970440
Name:ACADIA WOMEN'S HEALTH
Entity Type:Organization
Organization Name:ACADIA WOMEN'S HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-785-2006
Mailing Address - Street 1:527 ODD FELLOWS RD STE B
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-2208
Mailing Address - Country:US
Mailing Address - Phone:337-785-2006
Mailing Address - Fax:337-785-2016
Practice Address - Street 1:527 ODD FELLOWS RD STE B
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-2208
Practice Address - Country:US
Practice Address - Phone:337-785-2006
Practice Address - Fax:337-785-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1949906Medicaid