Provider Demographics
NPI:1396088464
Name:PROGRESSIVE ACUTE CARE PHYSICIAN SERVICES , LLC
Entity type:Organization
Organization Name:PROGRESSIVE ACUTE CARE PHYSICIAN SERVICES , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:VARNADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-624-7401
Mailing Address - Street 1:2210 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-1872
Mailing Address - Country:US
Mailing Address - Phone:985-624-7401
Mailing Address - Fax:
Practice Address - Street 1:1100 ANDRE ST STE 101
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2159
Practice Address - Country:US
Practice Address - Phone:337-369-9309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROGRESSIVE ACUTE CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-27
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty