Provider Demographics
NPI:1205973880
Name:ACADIA WALK IN CLINIC
Entity type:Organization
Organization Name:ACADIA WALK IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANI
Authorized Official - Middle Name:SALEM
Authorized Official - Last Name:MOUAWAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-289-6770
Mailing Address - Street 1:PO BOX 2009
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-2009
Mailing Address - Country:US
Mailing Address - Phone:337-289-6770
Mailing Address - Fax:337-289-6718
Practice Address - Street 1:6100 CAMERON STREET
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583
Practice Address - Country:US
Practice Address - Phone:337-289-6770
Practice Address - Fax:337-289-6718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.12254R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1441457Medicaid
LA5E640Medicare ID - Type Unspecified