Provider Demographics
NPI:1780614800
Name:ACADIANA MEDICAL LABORATORIES, LTD.
Entity type:Organization
Organization Name:ACADIANA MEDICAL LABORATORIES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-5711
Mailing Address - Street 1:217 RUE FRANCE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-233-5711
Mailing Address - Fax:337-233-7836
Practice Address - Street 1:217 RUE FRANCE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-233-5711
Practice Address - Fax:377-233-7836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1125610Medicaid
LA1125610Medicaid