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Organization
PROGRESSIVE ACUTE CARE PHYSICIAN SERVICES DAUTERIVE LLC
Active
Organization
PROGRESSIVE ACUTE CARE PHYSICIAN SERVICES DAUTERIVE LLC
Active
Other names
Legacy Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE D THOMPSON (CFO)
(985) 624-7401
Entity
Organization
Contact information
Practice address
1100 ANDRE ST, SUITE 101, NEW IBERIA, LA 70563-2159
(337) 369-9309
(337) 365-8455
Mailing address
PO BOX 11539, NEW IBERIA, LA 70562-1539
(337) 369-3481
(337) 365-8455
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
Other
Enumeration date
05/07/2008
Last updated
05/23/2014
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