| Medicine Clinic Of Acadiana, Llc | |
|
401 Youngsville Hwy Ste 200c Lafayette LA 70508-5173 | |
| (337) 330-8523 | |
| (337) 354-2336 |
| Full Name | Medicine Clinic Of Acadiana, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 401 Youngsville Hwy Ste 200c, Lafayette, Louisiana |
| Authorized Official Name and Position | Antoinette Rabenaldt (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 3376088988 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medicine Clinic Of Acadiana, Llc 302 Hacker St New Iberia LA 70560-4508 Ph: (337) 608-8988 | Medicine Clinic Of Acadiana, Llc 401 Youngsville Hwy Ste 200c Lafayette LA 70508-5173 Ph: (337) 330-8523 |
| NPI Number | 1588411144 |
|---|---|
| Provider Enumeration Date | 05/02/2024 |
| Last Update Date | 05/02/2024 |
| Medicare PECOS PAC ID | 4486191715 |
|---|---|
| Medicare Enrollment ID | O20240805003229 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588411144 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Himani Reddy Manthena |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689024911 PECOS PAC ID: 1456642271 Enrollment ID: I20191004000557 |
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