Provider Demographics
NPI:1861453201
Name:ACADIANA OTOLARYNGOLOGY HEAD AND NECK SURGERY LLC
Entity Type:Organization
Organization Name:ACADIANA OTOLARYNGOLOGY HEAD AND NECK SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-7174
Mailing Address - Street 1:PO BOX 52068
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2068
Mailing Address - Country:US
Mailing Address - Phone:337-233-7174
Mailing Address - Fax:337-269-0981
Practice Address - Street 1:515 S COLLEGE RD
Practice Address - Street 2:SUITE 255
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3352
Practice Address - Country:US
Practice Address - Phone:337-233-7174
Practice Address - Fax:337-269-0981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1945960Medicaid
5F652Medicare ID - Type Unspecified