Healthcare Provider Details

I. General information

NPI: 1386066769
Provider Name (Legal Business Name): ACADIANA CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2014
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W PINHOOK RD
LAFAYETTE LA
70508-3346
US

IV. Provider business mailing address

2501 W PINHOOK RD
LAFAYETTE LA
70508-3346
US

V. Phone/Fax

Practice location:
  • Phone: 337-269-0136
  • Fax:
Mailing address:
  • Phone: 337-269-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GORDON G GIDMAN
Title or Position: OWNER
Credential: MD
Phone: 337-269-0136