Provider Demographics
NPI:1194915348
Name:ACADIANA FAMILY MEDICAL CENTER, A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:ACADIANA FAMILY MEDICAL CENTER, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-684-6312
Mailing Address - Street 1:261 ADOLPH LN
Mailing Address - Street 2:
Mailing Address - City:BRANCH
Mailing Address - State:LA
Mailing Address - Zip Code:70516-3601
Mailing Address - Country:US
Mailing Address - Phone:337-684-6312
Mailing Address - Fax:
Practice Address - Street 1:810 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-4402
Practice Address - Country:US
Practice Address - Phone:337-684-6312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty