Healthcare Provider Details

I. General information

NPI: 1427236108
Provider Name (Legal Business Name): CHILDREN'S MULTI-SPECIALTY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 AMBASSADOR CAFFERY PARKWAY
LAFAYETTE LA
70508
US

IV. Provider business mailing address

4704 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508
US

V. Phone/Fax

Practice location:
  • Phone: 337-521-9250
  • Fax:
Mailing address:
  • Phone: 337-521-9250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICKEY S PICKLER
Title or Position: VICE PRESIDENT
Credential:
Phone: 816-508-4039