Provider Demographics
NPI:1780148197
Name:PALLIATIVE MEDICINE OF ACADIANA
Entity type:Organization
Organization Name:PALLIATIVE MEDICINE OF ACADIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-232-1234
Mailing Address - Street 1:2600 JOHNSTON ST STE 260
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3269
Mailing Address - Country:US
Mailing Address - Phone:337-232-1234
Mailing Address - Fax:337-232-0477
Practice Address - Street 1:2600 JOHNSTON ST STE 260
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3269
Practice Address - Country:US
Practice Address - Phone:337-232-1234
Practice Address - Fax:337-232-0477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty