=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346475522
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEART HOSPITAL OF ACADIANA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2009
-----------------------------------------------------
Last Update Date | 05/28/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2621 NORTH DR RM 2
-----------------------------------------------------
City | ABBEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70510-4078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-893-3694
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1105 KALISTE SALOOM RD
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70508-5705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-521-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | KAREN WYBLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 337-521-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 284300000X
-----------------------------------------------------
Taxonomy Name | Special Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------