Acadiana Vascular Center, LLC
Organization Active NPI Vascular Surgery Physician · Lafayette, LA
NPI 1083834352 · NPPES record last updated Feb 18, 2020
Key facts
- NPI
- 1083834352
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Vascular Surgery Physician 2086S0129X
- Legal business name
- ACADIANA VASCULAR CENTER, LLC
- Practice address
- 129 Rue Louis Xiv
Lafayette, LA 70508-5738 - Phone
- (337) 289-9700
- Fax
- (337) 289-9702
- NPI assigned
- Apr 27, 2007
- Organization subpart
- No
Authorized official
- Name
- Christopher E Lagraize, MD
- Title
- Owner
- Phone
- (337) 289-9700
Practitioners 7
-
Allen T Bui, MD
-
Michel Daly, FNP-C
-
John B Luke III, MD
-
Tami T Lagraize, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031216000048 | LA | Part B Supplier - Clinic/Group Practice | 1951208263 |
Receives reassigned benefits from 6 practitioners Practice locations: Lafayette, LA |
National Provider Directory
Locations
129 Rue Louis Xiv
Lafayette, LA 70508
Phone (337) 236-8911
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician |
2086S0129X | Yes |
Addresses
Primary practice location
129 Rue Louis Xiv
Lafayette, LA 70508-5738
Mailing address
129 Rue Louis Xiv
Lafayette, LA 70508-5738
Phone (337) 289-9700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1445819 | Medicaid | LA | |
| 435889460A | Other | LA | BLUE CROSS |
| 5CH18 | Other | LA | MEDICARE PTAN |
| 14474R | Other | LA | MEDICAL LICENSE |
Other providers in Lafayette, LA
- Acadiana Support Services, LLC
- Acadiana Support Services,LLC
- Acadiana Support Services,LLC
- Acadiana Urgent Care Associates, LLC
- Acadiana Urology LLC
- Acadiana Weight Loss Surgery
- Acadiana Women'S Health Group, Apmc
- Acadiana Wound Clinic LLC
- Acadiana Youth, Inc.
- Access Respiratory Homecare LLC
All providers in Lafayette, LA · Vascular Surgery Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.