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General NPI Number Information
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NPI Number | 1861088098
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Entity Type | Organization
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Legal Business Name | STRAWBERRY PATCH PEDIATRICS LLC
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 903 W OAK ST
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City | AMITE
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State | LA
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Zip | 70422-2754
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Country | US
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Telephone | 855-869-9898
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Fax |
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Provider Business Mailing Address
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Address Line | 903 W OAK ST
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City | AMITE
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State | LA
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Zip | 70422-2754
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ERNEST DRAKE
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Credential |
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Telephone | 225-278-7691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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