Healthcare Provider Details

I. General information

NPI: 1720148208
Provider Name (Legal Business Name): ACADIANA MEDICAL ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 JULIETTE PLACE
LAFAYETTE LA
70506-4571
US

IV. Provider business mailing address

PO BOX 52463
LAFAYETTE LA
70505-2463
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-2520
  • Fax: 337-232-9759
Mailing address:
  • Phone: 337-232-2520
  • Fax: 337-232-9759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number StateLA

VIII. Authorized Official

Name: MS. PAULETTE M BLANCHET
Title or Position: PRESIDENT
Credential: MD
Phone: 337-232-2520