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General NPI Number Information
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NPI Number | 1760545867
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Entity Type | Organization
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Legal Business Name | SHALOM CLINIC FOR CHILDREN APMC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 405 BIENVILLE ST
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City | NATCHITOCHES
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State | LA
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Zip | 71457-5748
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Country | US
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Telephone | 318-356-7211
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Fax | 318-356-7226
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Provider Business Mailing Address
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Address Line | 405 BIENVILLE ST
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City | NATCHITOCHES
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State | LA
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Zip | 71457-5748
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Country | US
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Telephone | 318-356-7211
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Fax | 318-356-7226
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OLUSEGUN ADEDAMOLA ADELEYE
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Credential | M.D.
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Telephone | 318-356-7211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 200937
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License Number State | LA
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