| Bioactive Infusion & Wellness, Llc | |
|
100 W Louisiana Ave Rayne LA 70578-5912 | |
| (337) 581-7009 | |
| Not Available |
| Full Name | Bioactive Infusion & Wellness, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 100 W Louisiana Ave, Rayne, Louisiana |
| Authorized Official Name and Position | Kimberly Gatte (CO-OWNER) |
| Authorized Official Contact | 3375817009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bioactive Infusion & Wellness, Llc 100 W Louisiana Ave Rayne LA 70578-5912 Ph: (337) 581-7009 | Bioactive Infusion & Wellness, Llc 100 W Louisiana Ave Rayne LA 70578-5912 Ph: (337) 581-7009 |
| NPI Number | 1770213217 |
|---|---|
| Provider Enumeration Date | 06/16/2022 |
| Last Update Date | 12/26/2023 |
| Medicare PECOS PAC ID | 4284018573 |
|---|---|
| Medicare Enrollment ID | O20220906002240 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770213217 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
| 261QI0500X | Clinic/center - Infusion Therapy | (* (Not Available)) | Secondary |
| Provider Name | Stephen R Cannon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083777908 PECOS PAC ID: 3577522424 Enrollment ID: I20041006000741 |
| Provider Name | Joni K Acclis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437830858 PECOS PAC ID: 2769838937 Enrollment ID: I20231024002237 |
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