MEDICARE: ORMOND PEDIATRIC GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1982055034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORMOND PEDIATRIC GROUP

Provider Business Mailing Address
First Line	:	141 ORMOND CENTER CT
Second Line	:
City	:	DESTREHAN
State	:	LA
Zip	:	70047-2548
Country	:	US
Telephone Number	:	985-764-7337
Fax Number	:	985-764-5333

Provider Business Practice Location Address
First Line	:	141 ORMOND CENTER CT
Second Line	:
City	:	DESTREHAN
State	:	LA
Zip	:	70047-2548
Country	:	US
Telephone Number	:	985-764-7337
Fax Number	:	985-764-5333

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CHERI RODRIGUEZ
Credential	:	MA
Telephone Number	:	985-764-7337

Provider Enumeration Date	:	06/29/2016
Last Update Date	:	06/29/2016

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