# PROGRESSIVE ACUTE CARE PHYSICIAN SERVICES DAUTERIVE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Legacy Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396911558
- **Authorized official:** WAYNE D THOMPSON (CFO)
- **Authorized official phone:** (985) 624-7401

## Contact information

- **Practice address:** 1100 ANDRE ST, SUITE 101, NEW IBERIA, LA 70563-2159
- **Practice address phone:** (337) 369-9309
- **Practice address fax:** (337) 365-8455
- **Mailing address:** PO BOX 11539, NEW IBERIA, LA 70562-1539
- **Mailing address phone:** (337) 369-3481
- **Mailing address fax:** (337) 365-8455

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 05/07/2008
- **Last updated:** 05/23/2014