Provider Demographics
NPI:1477586964
Name:ACADIANA ORTHOPAEDIC GROUP
Entity type:Organization
Organization Name:ACADIANA ORTHOPAEDIC GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-264-1171
Mailing Address - Street 1:1448 S COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2920
Mailing Address - Country:US
Mailing Address - Phone:337-264-1171
Mailing Address - Fax:337-706-1392
Practice Address - Street 1:1448 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2920
Practice Address - Country:US
Practice Address - Phone:337-264-1171
Practice Address - Fax:337-233-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACN8786OtherRAILROAD
LA5C006Medicare PIN
LACN8786OtherRAILROAD