MEDICARE: HEART HOSPITAL OF ACADIANA, LLC

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	284300000X	Special Hospital

General Provider Information

NPI Number	:	1346475522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART HOSPITAL OF ACADIANA, LLC

Provider Business Mailing Address
First Line	:	1105 KALISTE SALOOM RD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-5705
Country	:	US
Telephone Number	:	337-521-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2621 NORTH DR RM 2
Second Line	:
City	:	ABBEVILLE
State	:	LA
Zip	:	70510-4078
Country	:	US
Telephone Number	:	337-893-3694
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	KAREN WYBLE
Credential	:
Telephone Number	:	337-521-1000

Provider Enumeration Date	:	05/18/2009
Last Update Date	:	05/28/2009

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