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NPI Code Detail

MEDICARE: HARRIS MEMORIAL PEDIATRIC CLINIC, LLC

MEDICARE: HARRIS MEMORIAL PEDIATRIC CLINIC, 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
1261QP2300XPrimary Care Clinic/Center

General Provider Information

NPI Number : 1285065383
Entity Type Code : Organization
Provider Name (Legal Business Name) : HARRIS MEMORIAL PEDIATRIC CLINIC, LLC
Provider Business Mailing Address
First Line : 4571 N MARKET ST
Second Line :
City : SHREVEPORT
State : LA
Zip : 71107-2917
Country : US
Telephone Number : 888-958-7561
Fax Number :
Provider Business Practice Location Address
First Line : 4571 N MARKET ST
Second Line :
City : SHREVEPORT
State : LA
Zip : 71107-2917
Country : US
Telephone Number : 888-958-7561
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. CATRELL J MCCULLOCH
Credential : M.D.
Telephone Number : 888-958-7561
Provider Enumeration Date : 11/29/2013
Last Update Date : 11/29/2013

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Directions to “HARRIS MEMORIAL PEDIATRIC CLINIC, LLC ” Practice Location

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