Healthcare Provider Details

I. General information

NPI: 1982771663
Provider Name (Legal Business Name): THE CHILDRENS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 RIDGEFIELD RD
THIBODAUX LA
70301
US

IV. Provider business mailing address

807 RIDGEFIELD RD
THIBODAUX LA
70301
US

V. Phone/Fax

Practice location:
  • Phone: 985-447-9045
  • Fax: 985-447-3349
Mailing address:
  • Phone: 985-447-9045
  • Fax: 985-447-3349

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. SHEILA G PITRE
Title or Position: MD PARTNER
Credential: MD
Phone: 985-447-9045