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General NPI Number Information
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NPI Number | 1821089665
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Entity Type | Organization
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Legal Business Name | ACADIANA SURGICAL CLINIC INC
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Dates
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Enumeration Date | 11/01/2005
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Last Update Date | 11/09/2011
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Provider Practice Location Address
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Address Line | 3975 I 49 S SERVICE RD SUITE 105
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City | OPELOUSAS
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State | LA
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Zip | 70570-0775
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Country | US
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Telephone | 337-948-7680
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Fax | 337-948-1143
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Provider Business Mailing Address
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Address Line | 3975 I 49 S SERVICE RD SUITE 105
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City | OPELOUSAS
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State | LA
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Zip | 70570-0775
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Country | US
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Telephone | 337-948-7680
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Fax | 337-948-1143
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Authorized Official
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Title or Position | OWNER/MD
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Name | DR. GLYNN A. GRANGER
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Credential | MD
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Telephone | 337-948-7680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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