Provider Demographics
NPI:1669598322
Name:ACADIANA CENTER FOR ORTHOPEDIC & OCCUPATIONAL
Entity type:Organization
Organization Name:ACADIANA CENTER FOR ORTHOPEDIC & OCCUPATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:DEPRIEST
Authorized Official - Last Name:LEVASSEUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-269-0136
Mailing Address - Street 1:2501 WEST PINHOOK ROAD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3818
Mailing Address - Country:US
Mailing Address - Phone:337-269-0136
Mailing Address - Fax:337-233-8525
Practice Address - Street 1:2501 WEST PINHOOK ROAD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3818
Practice Address - Country:US
Practice Address - Phone:337-269-0136
Practice Address - Fax:337-233-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012306174400000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1457591Medicaid
E56663Medicare UPIN
LAE56663Medicare UPIN
LA5M407Medicare ID - Type Unspecified