Healthcare Provider Details

I. General information

NPI: 1144495334
Provider Name (Legal Business Name): ACUTE CARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 HERMITAGE DR
THIBODAUX LA
70301-2914
US

IV. Provider business mailing address

1208 CANAL BLVD
THIBODAUX LA
70301-4511
US

V. Phone/Fax

Practice location:
  • Phone: 985-448-0827
  • Fax: 985-448-0822
Mailing address:
  • Phone: 985-448-0827
  • Fax: 985-448-0822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberMD06503R
License Number StateLA

VIII. Authorized Official

Name: MRS. AYANNA A ALVEREZ
Title or Position: DIRECTOR
Credential:
Phone: 504-382-6011