MEDICARE: SOUTHSIDE PEDIATRICS. A.P.M.C.

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1609334390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHSIDE PEDIATRICS. A.P.M.C.

Provider Business Mailing Address
First Line	:	811 ALBERTSON PKWY STE A
Second Line	:
City	:	BROUSSARD
State	:	LA
Zip	:	70518-5256
Country	:	US
Telephone Number	:	337-839-2238
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 ALBERTSON PKWY STE A
Second Line	:
City	:	BROUSSARD
State	:	LA
Zip	:	70518-5256
Country	:	US
Telephone Number	:	337-839-2238
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CARLOS BRUNO
Credential	:	MD
Telephone Number	:	337-839-2238

Provider Enumeration Date	:	03/12/2019
Last Update Date	:	03/12/2019

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Directions to “SOUTHSIDE PEDIATRICS. A.P.M.C. ” Practice Location

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