| Stacey W Mayeaux MD LLC | |
|
519 E Prudhomme St Opelousas LA 70570-6499 | |
| (337) 678-3755 | |
| (337) 678-3757 |
| Full Name | Stacey W Mayeaux MD LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 519 E Prudhomme St, Opelousas, Louisiana |
| Authorized Official Name and Position | Stacey Wayne Mayeaux (OWNER OPERATOR) |
| Authorized Official Contact | 3376783755 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stacey W Mayeaux MD LLC Po Box 8 Opelousas LA 70571-0008 Ph: (337) 678-3755 | Stacey W Mayeaux MD LLC 519 E Prudhomme St Opelousas LA 70570-6499 Ph: (337) 678-3755 |
| NPI Number | 1710163340 |
|---|---|
| Provider Enumeration Date | 01/14/2008 |
| Last Update Date | 10/31/2017 |
| Medicare PECOS PAC ID | 2860575727 |
|---|---|
| Medicare Enrollment ID | O20080215000157 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710163340 | NPI | - | NPPES |
| 1013986892 | Other | LA | NPI |
| 1423271 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
| Provider Name | Stacey W Mayeaux |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013986892 PECOS PAC ID: 9830151679 Enrollment ID: I20041103000220 |
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