Healthcare Provider Details

I. General information

NPI: 1801070164
Provider Name (Legal Business Name): PEDIATRIC CLINIC OF NORTHEAST LA A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 LAMY LN
MONROE LA
71201-3735
US

IV. Provider business mailing address

1217 DEAN CHAPEL RD
WEST MONROE LA
71291-7609
US

V. Phone/Fax

Practice location:
  • Phone: 318-387-3453
  • Fax: 318-323-9045
Mailing address:
  • Phone:
  • 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: DR. FRANCES MEADE O'BOYLE
Title or Position: PRESIDENT
Credential:
Phone: 318-325-0483