Healthcare Provider Details

I. General information

NPI: 1023067899
Provider Name (Legal Business Name): SHALOM CLINIC FOR CHILDREN RHC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W COURT ST SUITE B
WINNFIELD LA
71483-2633
US

IV. Provider business mailing address

609 W COURT ST SUITE B
WINNFIELD LA
71483-2633
US

V. Phone/Fax

Practice location:
  • Phone: 318-648-5518
  • Fax:
Mailing address:
  • Phone: 318-628-5518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. OLABISI O OSHIKANLU
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 318-628-5518