Healthcare Provider Details

I. General information

NPI: 1215156898
Provider Name (Legal Business Name): RHODES PEDIATRIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 CALVERT DR
ALEXANDRIA LA
71303-3520
US

IV. Provider business mailing address

37 CALVERT DR
ALEXANDRIA LA
71303
US

V. Phone/Fax

Practice location:
  • Phone: 318-443-9634
  • Fax: 318-443-9809
Mailing address:
  • Phone: 318-443-9634
  • Fax: 318-443-9809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number019609
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number022304
License Number StateLA

VIII. Authorized Official

Name: DR. JOHN N RHODES
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 318-443-9634