Provider Demographics
NPI:1720288046
Name:ACADIANA UROLOGY LLC
Entity Type:Organization
Organization Name:ACADIANA UROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE TEAM LEADER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-289-9155
Mailing Address - Street 1:1000 W PINHOOK RD
Mailing Address - Street 2:STE 304
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2460
Mailing Address - Country:US
Mailing Address - Phone:337-289-9155
Mailing Address - Fax:337-289-9585
Practice Address - Street 1:1000 W PINHOOK RD
Practice Address - Street 2:STE 304
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2460
Practice Address - Country:US
Practice Address - Phone:337-289-9155
Practice Address - Fax:337-289-9585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CP99Medicare PIN
LADD1419Medicare PIN