1720489362 NPI number — ACADIANA RADIATION THERAPY LLC

Table of content: (NPI 1720489362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720489362 NPI number — ACADIANA RADIATION THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACADIANA RADIATION THERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720489362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 WOODMONT BLVD
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37205-2245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-783-1254
Provider Business Mailing Address Fax Number:
615-783-1082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 N LEWIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW IBERIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70563-2015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-364-1131
Provider Business Practice Location Address Fax Number:
337-367-5750
Provider Enumeration Date:
09/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BITTING
Authorized Official First Name:
STUART
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT AND CFO
Authorized Official Telephone Number:
615-467-7400

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2384422 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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