Provider Demographics
NPI:1003286725
Name:PEDIATRIC CENTER FOR RESPIRATORY MEDICINE
Entity Type:Organization
Organization Name:PEDIATRIC CENTER FOR RESPIRATORY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:W
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-413-8653
Mailing Address - Street 1:2355 DRUSILLA LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1443
Mailing Address - Country:US
Mailing Address - Phone:225-413-8653
Mailing Address - Fax:225-231-1995
Practice Address - Street 1:2355 DRUSILLA LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1443
Practice Address - Country:US
Practice Address - Phone:225-413-8653
Practice Address - Fax:225-231-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019485174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty