Healthcare Provider Details

I. General information

NPI: 1487854949
Provider Name (Legal Business Name): GASTROENTEROLOGY CLINIC OF ACADIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 COOLIDGE BLVD SUITE 303
LAFAYETTE LA
70503-2636
US

IV. Provider business mailing address

PO BOX 51125
LAFAYETTE LA
70505-1125
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-6697
  • Fax: 337-232-3147
Mailing address:
  • Phone: 337-232-6697
  • Fax: 337-232-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN G. ABSHIRE
Title or Position: CEO
Credential:
Phone: 337-232-6697