Provider Demographics
NPI:1245364819
Name:ACADIANA MEDICINE CLINIC, APMC
Entity type:Organization
Organization Name:ACADIANA MEDICINE CLINIC, APMC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:Y
Authorized Official - Last Name:BORDELON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:337-948-7090
Mailing Address - Street 1:1200 HOSPITAL DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6552
Mailing Address - Country:US
Mailing Address - Phone:337-948-7090
Mailing Address - Fax:337-942-8108
Practice Address - Street 1:1200 HOSPITAL DR
Practice Address - Street 2:SUITE 4
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6552
Practice Address - Country:US
Practice Address - Phone:337-948-7090
Practice Address - Fax:337-942-8108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024044207RP1001X
LA012611207RS0012X
LAAP03450363LF0000X
LA015719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACP7403OtherRAILROADMEDICAREGRPPROV#
LA1946931Medicaid
LA=========0OtherBLUE CROSS GRP PROVIDER #
LA=========OtherTRICARE GRP PROVIDER #
LA57863Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #