# PEDIATRIC GROUP OF ACADIANA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** St. Martinville Maternal-Child and Adult Clinic, St. Martinville Maternal-Child Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922283225
- **Authorized official:** ALEC MOYER (BUSINESS MANAGER)
- **Authorized official phone:** (337) 256-5111

## Contact information

- **Practice address:** 1119 N MAIN ST, SAINT MARTINVILLE, LA 70582-3513
- **Practice address phone:** (337) 394-7774
- **Mailing address:** 401 YOUNGSVILLE HWY STE 100, LAFAYETTE, LA 70508-5173
- **Mailing address phone:** (337) 330-0031

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 10447R | LA | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/04/2008
- **Last updated:** 12/16/2019