MEDICARE: KIDNEY CARE OF ACADIANA IN LAFAYETTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	261Q00000X	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245304674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDNEY CARE OF ACADIANA IN LAFAYETTE

Provider Business Mailing Address
First Line	:	224 SAINT LANDRY ST
Second Line	:	SUITE 3-C
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-3549
Country	:	US
Telephone Number	:	337-231-5511
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 SAINT LANDRY ST
Second Line	:	SUITE 3-C
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-3549
Country	:	US
Telephone Number	:	337-231-5511
Fax Number	:

Authorized Official
Title or Position	:	OWNER MEDICAL DIREC TOR
Name	:	DR. MASOUD YAZDI
Credential	:	MD
Telephone Number	:	337-233-3538

Provider Enumeration Date	:	11/18/2006
Last Update Date	:	08/22/2020

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Directions to “KIDNEY CARE OF ACADIANA IN LAFAYETTE ” Practice Location

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