Healthcare Provider Details

I. General information

NPI: 1912165341
Provider Name (Legal Business Name): CHILDRENS HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3521 HIGHWAY 190 STE N
EUNICE LA
70535-5135
US

IV. Provider business mailing address

3521 HIGHWAY 190 STE N
EUNICE LA
70535-5135
US

V. Phone/Fax

Practice location:
  • Phone: 337-550-1175
  • Fax: 337-550-1176
Mailing address:
  • Phone: 337-550-1175
  • Fax: 337-550-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number022507
License Number StateLA

VIII. Authorized Official

Name: TODD H. PULLIN
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 337-550-1175