MEDICARE: TKZ PEDIATRICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	MD204356	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184964975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TKZ PEDIATRICS LLC

Provider Business Mailing Address
First Line	:	4352 MCCOY BYRNES RD
Second Line	:
City	:	ETHEL
State	:	LA
Zip	:	70730-4060
Country	:	US
Telephone Number	:	225-658-7860
Fax Number	:	225-658-7862

Provider Business Practice Location Address
First Line	:	9305 MAIN ST
Second Line	:	SUITE D
City	:	ZACHARY
State	:	LA
Zip	:	70791-7441
Country	:	US
Telephone Number	:	225-658-7860
Fax Number	:	225-658-7862

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	DR. TAIRA LYNN WOODROFFE
Credential	:	MD
Telephone Number	:	225-658-7860

Provider Enumeration Date	:	02/15/2013
Last Update Date	:	02/15/2013

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Directions to “TKZ PEDIATRICS LLC ” Practice Location

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