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 / Primary Care, which is considered as the primary health care specialty. Southern Pediatric Clinic can be contacted via phone (318) 221-0277, or through Immanuel, Stella via phone (318) 730-9760.

Contact Information

Primary practice address
202 N Thomas Dr Suite 1 Shreveport LA 71107-6539
Phone: (318) 221-0277
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Immanuel, Stella Doctor of Medicine (MD)
Phone: (318) 730-9760

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Primary Care 261QP2300X MD12866R Louisiana

Profile Details

NPI number 1528432440
LBN Legal business name Southern Pediatric Clinic
DBA Doing business as Southern Pediatric Clinic
Authorized official Immanuel, Stella Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Nov 16th, 2015
Last updated Nov 16th, 2015 - about 9 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 1528432440 NPPES
Louisiana MEDICAID 1449237

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