Provider Demographics
NPI:1336965508
Name:PEDIATRIC GROUP OF ACADIANA LLC
Entity type:Organization
Organization Name:PEDIATRIC GROUP OF ACADIANA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RABENALDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-330-2576
Mailing Address - Street 1:302 HACKER ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4508
Mailing Address - Country:US
Mailing Address - Phone:337-330-2576
Mailing Address - Fax:337-321-6295
Practice Address - Street 1:2825 GRAND POINT HWY LOT 6
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:LA
Practice Address - Zip Code:70517-6972
Practice Address - Country:US
Practice Address - Phone:337-454-6238
Practice Address - Fax:337-408-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty