SOUTHERN PEDIATRIC CLINIC NPI 1104296417

NPI Information

SOUTHERN PEDIATRIC CLINIC is a health service clinic center in Oakdale, LA. SOUTHERN PEDIATRIC CLINIC NPI is 1104296417. The provider is registered as an organization entity type.

The provider's business location address is:

905 E 7TH AVE
SUITE 9
OAKDALE, LA
ZIP 71463-797
Phone: (318) 215-8150
Fax: (318) 215-8151

The provider's authorized official is Stella Grace Immanuel .
The authorized official title is Owner and has the following contact phone number (318) 215-8150.

The enumeration date for this NPI number is 9/29/2015 and was last updated on 11/3/2015.

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:

Other Identifiers

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

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