Healthcare Provider Details

I. General information

NPI: 1366434631
Provider Name (Legal Business Name): ACADIANA HEART CLINIC APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 HOSPITAL DR SUITE 203
LAFAYETTE LA
70503-2852
US

IV. Provider business mailing address

155 HOSPITAL DR SUITE 203
LAFAYETTE LA
70503-2852
US

V. Phone/Fax

Practice location:
  • Phone: 337-236-3411
  • Fax: 337-236-3118
Mailing address:
  • Phone: 337-236-3411
  • Fax: 337-236-3118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number016627
License Number StateLA

VIII. Authorized Official

Name: WILLIAM R GUILLORY JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 337-236-3411