Southern Pediatric Clinic

LBN: Southern Pediatric Clinic
Southern Pediatric Clinic is an health care organization with primary practice located at 202 N Thomas Dr Suite 1, Shreveport LA 71107-6539. The organization recently has only one registered license in Ambulatory Health Care Facilities / Health Service, which is considered as the primary health care specialty. Southern Pediatric Clinic can be contacted via phone (318) 221-0277, or through Immanuel, Stella Grace via phone (318) 221-0277.

Contact Information

Primary practice address
202 N Thomas Dr Suite 1 Shreveport LA 71107-6539
Phone: (318) 221-0277
Fax: (318) 221-3277
Website:
Map and Directions
Authorized official contact:
Name: Immanuel, Stella Grace Doctor of Medicine (MD)
Phone: (318) 221-0277

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Health Service 261QH0100X MD12866R Louisiana

Profile Details

NPI number 1104297720
LBN Legal business name Southern Pediatric Clinic
DBA Doing business as
Authorized official Immanuel, Stella Grace Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Oct 8th, 2015
Last updated Nov 3rd, 2015 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104297720 NPPES
Louisiana MEDICAID 1449237

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