Active NPI
Adult Medicine and Diagnostic Center
- Clinic/Center
- Gonzales, LA
National Provider Identifier
1902173271
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- License
- 022083
- Legal business name
- ADULT MEDICINE AND DIAGNOSTIC CENTER
- Practice address
- 2211 S Burnside Ave Ste 4
Gonzales, LA 70737-4634 - Phone
- (225) 647-1947
- Fax
- (225) 644-3943
- NPI assigned
- Nov 30, 2011
- Last updated
- Sep 2, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Hanna Kalinowska Vazquez
- Title
- Office Manager
- Phone
- (225) 647-1947
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | 022083 | LA | Primary |
Addresses
Primary practice location
2211 S Burnside Ave Ste 4
Gonzales, LA 70737-4634
Mailing address
2211 S Burnside Ave Ste 4
Gonzales, LA 70737-4634
Phone (225) 647-1947
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
Enrollment records 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 19D0972006 | Adult Medicine | Certificate of waiver | Mar 27, 2028 |
National Provider Directory
National Provider DirectoryLocations
2211 S Burnside Ave
Ste 4
Gonzales, LA 70737
Phone (224) 647-1947
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Internal Medicine Physician
- Gonzales, LA
- NPI 1326076266
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322611200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1472774400000",
"number": "1902173271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2211 S BURNSIDE AVE STE 4",
"city": "GONZALES",
"state": "LA",
"postal_code": "707374634",
"telephone_number": "225-647-1947",
"fax_number": "225-644-3943"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2211 S BURNSIDE AVE STE 4",
"city": "GONZALES",
"state": "LA",
"postal_code": "707374634",
"telephone_number": "225-647-1947",
"fax_number": "225-644-3943"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ADULT MEDICINE AND DIAGNOSTIC CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2011-11-30",
"last_updated": "2016-09-02",
"status": "A",
"authorized_official_last_name": "VAZQUEZ",
"authorized_official_first_name": "HANNA",
"authorized_official_middle_name": "KALINOWSKA",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "225-647-1947",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "LA",
"license": "022083",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Gonzales, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.