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General NPI Number Information
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NPI Number | 1821042086
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Entity Type | Organization
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Legal Business Name | SULPHUR PEDIATRIC CLINIC MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 600 CYPRESS STREET
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City | SULPHUR
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State | LA
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Zip | 70663-5052
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Country | US
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Telephone | 337-527-6371
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Fax | 337-528-9616
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Provider Business Mailing Address
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Address Line | 600 CYPRESS STREET
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City | SULPHUR
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State | LA
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Zip | 70663-5052
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Country | US
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Telephone | 337-527-6371
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Fax | 337-528-9616
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Authorized Official
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Title or Position | CO/OWNER
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Name | DR. ALBERT W. RICHERT SR.
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Credential | M.D.
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Telephone | 337-527-6371
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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 | 011494
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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