Healthcare Provider Details

I. General information

NPI: 1124828652
Provider Name (Legal Business Name): CATH LAB AMBULATORY CENTER CARDIOLOGY SPECIALIST OF ACADIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 03/14/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 RUE LOUIS XIV
LAFAYETTE LA
70508-7050
US

IV. Provider business mailing address

309 RUE LOUIS XIV
LAFAYETTE LA
70508
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 TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BOBBY ROUSE
Title or Position: CFO
Credential: CFO
Phone: 901-219-8656