| Pediatric Group Of Acadiana, Llc | |
|
12713 Water Way Maurepas LA 70449-1200 | |
| (225) 698-0211 | |
| (225) 424-6009 |
| Full Name | Pediatric Group Of Acadiana, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 12713 Water Way, Maurepas, Louisiana |
| Authorized Official Name and Position | Antoinette Rabenaldt (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 3373302576 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Group Of Acadiana, Llc 302 Hacker St New Iberia LA 70560-4508 Ph: (337) 330-2576 | Pediatric Group Of Acadiana, Llc 12713 Water Way Maurepas LA 70449-1200 Ph: (225) 698-0211 |
| NPI Number | 1588138903 |
|---|---|
| Provider Enumeration Date | 01/18/2019 |
| Last Update Date | 12/03/2024 |
| Medicare PECOS PAC ID | 2466476023 |
|---|---|
| Medicare Enrollment ID | O20190222001392 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588138903 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Our Lady Of The Lake Physician Group, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 18740 Highway 22, Maurepas, LA 70449 Phone: 225-698-3435 Fax: 225-698-6446 |