Healthcare Provider Details

I. General information

NPI: 1588968994
Provider Name (Legal Business Name): PATRICIA M SCHNEIDER MD PEDATRIC CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10273 GOULD DRIVE
SAINT FRANCISVILLE LA
70775-0487
US

IV. Provider business mailing address

PO BOX 1219
SAINT FRANCISVILLE LA
70775-1219
US

V. Phone/Fax

Practice location:
  • Phone: 225-635-9065
  • Fax: 225-635-9069
Mailing address:
  • Phone: 225-635-9065
  • Fax: 225-635-9069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number012764
License Number StateLA

VIII. Authorized Official

Name: DR. PATRICIA M SCHNEIDER
Title or Position: OWNER
Credential: M.D.
Phone: 225-635-9065