# PEDIATRIC GROUP OF ACADIANA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Waterway Pediatrics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588138903
- **Authorized official:** ANTOINETTE RABENALDT (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (337) 330-2576

## Contact information

- **Practice address:** 12713 WATER WAY, MAUREPAS, LA 70449-1200
- **Practice address phone:** (225) 698-0211
- **Practice address fax:** (225) 424-6009
- **Mailing address:** 302 HACKER ST, NEW IBERIA, LA 70560-4508
- **Mailing address phone:** (337) 330-2576
- **Mailing address fax:** (337) 321-6295

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/18/2019
- **Last updated:** 12/03/2024