Provider Demographics
NPI:1043244163
Name:NARAYANAN PEDIATRIC CLINIC
Entity Type:Organization
Organization Name:NARAYANAN PEDIATRIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN OFFICE SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-895-9498
Mailing Address - Street 1:PO BOX 170 DEPT 150
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671
Mailing Address - Country:US
Mailing Address - Phone:662-895-9498
Mailing Address - Fax:662-890-4547
Practice Address - Street 1:3964 GOODMAN
Practice Address - Street 2:STE 133
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672
Practice Address - Country:US
Practice Address - Phone:662-895-9498
Practice Address - Fax:662-890-4547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center