Healthcare Provider Details

I. General information

NPI: 1245364819
Provider Name (Legal Business Name): ACADIANA MEDICINE CLINIC, APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HOSPITAL DR SUITE 4
OPELOUSAS LA
70570-6552
US

IV. Provider business mailing address

1200 HOSPITAL DR SUITE 4
OPELOUSAS LA
70570-6552
US

V. Phone/Fax

Practice location:
  • Phone: 337-948-7090
  • Fax: 337-942-8108
Mailing address:
  • Phone: 337-948-7090
  • Fax: 337-942-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP03450
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number015719
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number024044
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number012611
License Number StateLA

VIII. Authorized Official

Name: DR. JOSEPH Y. BORDELON JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 337-948-7090