Provider Demographics
NPI:1528267176
Name:ACADIANA BONE & JOINT CLINIC, APMC
Entity type:Organization
Organization Name:ACADIANA BONE & JOINT CLINIC, APMC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-898-1900
Mailing Address - Street 1:215 ODEA ST
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-4065
Mailing Address - Country:US
Mailing Address - Phone:337-898-1900
Mailing Address - Fax:337-898-1901
Practice Address - Street 1:215 ODEA ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4065
Practice Address - Country:US
Practice Address - Phone:337-898-1900
Practice Address - Fax:337-898-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013954207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1310921Medicaid
LAP00641131OtherRAILROAD MEDICARE PART B
LAP00641131OtherRAILROAD MEDICARE PART B
LA1310921Medicaid