Provider Demographics
NPI:1780075200
Name:ACADIANA OB/GYN, LLC
Entity type:Organization
Organization Name:ACADIANA OB/GYN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SLOVACEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-261-5433
Mailing Address - Street 1:1211 COOLIDGE BLVD
Mailing Address - Street 2:STE 403
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2636
Mailing Address - Country:US
Mailing Address - Phone:337-261-5433
Mailing Address - Fax:337-269-9652
Practice Address - Street 1:1211 COOLIDGE BLVD
Practice Address - Street 2:STE 403
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2636
Practice Address - Country:US
Practice Address - Phone:337-261-5433
Practice Address - Fax:337-269-9652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.016206207V00000X
LAMD206213207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty