| Organization Name: | PEDIATRIC GROUP OF ACADIANA, LLC |
| NPI Number: | 1922283225 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | INGRID RENEE GILLESPIE (DIRECTOR OF OPERATIONS) |
| Mailing Address: | 1119 N Main St Saint Martinville |
| State: | LA US |
| Postal Code: | 705823513 |
| Phone Number: | 3373947774 |
| Fax Number: | |
| NPI Enumeration Date: | 01/04/2008 |
| NPI Last Update Date: | 12/12/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 10447R |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | LA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |