Healthcare Provider Details

I. General information

NPI: 1396911558
Provider Name (Legal Business Name): PROGRESSIVE ACUTE CARE PHYSICIAN SERVICES DAUTERIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 11539
NEW IBERIA LA
70562-1539
US

V. Phone/Fax

Practice location:
  • Phone: 337-369-9309
  • Fax: 337-365-8455
Mailing address:
  • Phone: 337-369-3481
  • Fax: 337-365-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WAYNE D THOMPSON
Title or Position: CFO
Credential:
Phone: 985-624-7401