Healthcare Provider Details

I. General information

NPI: 1275545170
Provider Name (Legal Business Name): ACADIAN MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 SHIRLEY RD
BUNKIE LA
71322-1585
US

IV. Provider business mailing address

PO BOX 700
BUNKIE LA
71322-0700
US

V. Phone/Fax

Practice location:
  • Phone: 337-654-5738
  • Fax:
Mailing address:
  • Phone: 337-654-5738
  • Fax: 318-838-2368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: DERRICK GLENN EARLES
Title or Position: OWNER
Credential: ESQ.
Phone: 337-654-5738