# PEDIATRIC GROUP OF ACADIANA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pediatric Group of Acadiana & Church Point Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619471463
- **Authorized official:** ANTOINETTE RABENALDT (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (337) 330-2576

## Contact information

- **Practice address:** 1048 EAST EBEY STREET, CHURCH POINT, LA 70525-7052
- **Practice address phone:** (337) 684-3000
- **Practice address fax:** (337) 210-2860
- **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 | — | LA | Yes |

## Other

- **Enumeration date:** 03/19/2018
- **Last updated:** 12/03/2024