1871670752 NPI number — CENLA CHILDREN'S CLINIC & ASSOCIATES

Table of content: (NPI 1871670752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871670752 NPI number — CENLA CHILDREN'S CLINIC & ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENLA CHILDREN'S CLINIC & ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PINEVILLE CHILDREN'S CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871670752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 MEDICAL CENTER DR # 30140 SUITE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71301-8124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-487-1358
Provider Business Mailing Address Fax Number:
318-487-9584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 MEDICAL CENTER DR # 30140 SUITE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71301-8124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-487-1358
Provider Business Practice Location Address Fax Number:
318-487-9584
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REDDY
Authorized Official First Name:
C
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
318-487-1358

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1740283852 . This is a "DR. DANIVAS NPI#" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1682152 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1196371 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1053314187 . This is a "DR. BHARGAVA'S NPI#" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1435775 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730182866 . This is a "DR REDDY'S NPI#" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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