Organization
ACADIANA SURGICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLYNN A. GRANGER MD (OWNER/MD)
(337) 948-7680
Entity
Organization
Contact information
Practice address
3975 I 49 S SERVICE RD, SUITE 105, OPELOUSAS, LA 70570-0775
(337) 948-7680
(337) 948-1143
Mailing address
3975 I 49 S SERVICE RD, SUITE 105, OPELOUSAS, LA 70570-0775
(337) 948-7680
(337) 948-1143
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457221
—
LA
01
—
CN6611
RAILROAD MEDICARE
LA
Enumeration date
11/01/2005
Last updated
11/09/2011
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