Healthcare Provider Details

I. General information

NPI: 1215770037
Provider Name (Legal Business Name): CARDIOLOGY SPECIALISTS OF ACADIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 RUE FONTAINE
LAFAYETTE LA
70508-5742
US

IV. Provider business mailing address

213 RUE FONTAINE
LAFAYETTE LA
70508-5742
US

V. Phone/Fax

Practice location:
  • Phone: 337-269-9777
  • Fax: 337-269-0244
Mailing address:
  • Phone: 337-269-9777
  • Fax: 337-269-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0404X
TaxonomyCardiac Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REGAN LYNN VIATOR
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 337-269-9777