Healthcare Provider Details

I. General information

NPI: 1396088464
Provider Name (Legal Business Name): PROGRESSIVE ACUTE CARE PHYSICIAN SERVICES , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 ANDRE ST STE 101
NEW IBERIA LA
70563-2159
US

IV. Provider business mailing address

2210 7TH ST
MANDEVILLE LA
70471-1872
US

V. Phone/Fax

Practice location:
  • Phone: 337-369-9309
  • Fax:
Mailing address:
  • Phone: 985-624-7401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DONNA D VARNADO
Title or Position: VP BUSINESS SERVICES
Credential:
Phone: 985-624-7401