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PEDIATRIC MEDICAL CLINIC INC NPI 1043376007


NPI Information

NPI: 1043376007
Provider Name: PEDIATRIC MEDICAL CLINIC INC
Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

CLIA Number: 19D0705206

Address:
501 RUE DE SANTE
SUITE 9
LA PLACE, LA
ZIP 70068
Phone: (985) 651-7444
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PEDIATRIC MEDICAL CLINIC INC is an adolescent medicine pediatrics in La Place, LA. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. PEDIATRIC MEDICAL CLINIC INC NPI is 1043376007. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

501 RUE DE SANTE
SUITE 9
LA PLACE, LA
ZIP 70068-400
Phone: (985) 651-7444
Fax: (985) 651-7449

The provider's authorized official is Oliver Roy Lambert .
The authorized official title is Physician and has the following contact phone number (985) 651-7444.

The CLIA number assigned to this NPI record is 19D0705206 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/27/2006 and was last updated on 7/16/2007.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12080A0000XPediatricsAdolescent Medicine015291LOUISIANAYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11449369MEDICAIDLOUISIANA

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: 5/5/2024

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