1952519639 NPI number — ROSALES CHILDREN'S CLINIC

Table of content: (NPI 1952519639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952519639 NPI number — ROSALES CHILDREN'S CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSALES CHILDREN'S CLINIC
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:
Provider Other Organization Name Type Code:
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:
1952519639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 CONTEMPO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71291-5312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-807-1360
Provider Business Mailing Address Fax Number:
318-807-1364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 CONTEMPO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71291-7366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-338-3585
Provider Business Practice Location Address Fax Number:
318-338-3588
Provider Enumeration Date:
05/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHOWS
Authorized Official First Name:
KIMBERLI
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
318-338-3585

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  RN070425 AP03721 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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