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PEDIATRIC CLINIC OF LAFAYETTE LLC NPI 1184387177


NPI Information

NPI: 1184387177
Provider Name: PEDIATRIC CLINIC OF LAFAYETTE LLC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 19D1007628

Address:
104 GENEVIEVE DR
LAFAYETTE, LA
ZIP 70503
Phone: (337) 984-0110
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PEDIATRIC CLINIC OF LAFAYETTE LLC is a pediatrics in Lafayette, LA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. PEDIATRIC CLINIC OF LAFAYETTE LLC NPI is 1184387177. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

104 GENEVIEVE DR
LAFAYETTE, LA
ZIP 70503-811
Phone: (337) 984-0110
Fax: (337) 981-7210

The provider's authorized official is Usha Krishnamoorthy .
The authorized official title is Billing Office and has the following contact phone number (337) 322-6673.

The CLIA number assigned to this NPI record is 19D1007628 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/18/2021 and was last updated on 10/18/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
12138332MEDICAIDLOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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