Provider Demographics
NPI:1083737845
Name:ALL KIDS R US MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:ALL KIDS R US MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:318-388-5030
Mailing Address - Street 1:PO BOX 685
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294-0685
Mailing Address - Country:US
Mailing Address - Phone:318-388-5030
Mailing Address - Fax:318-388-7134
Practice Address - Street 1:2933 CYPRESS STREET
Practice Address - Street 2:SUITE 1 HALL A
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291
Practice Address - Country:US
Practice Address - Phone:318-388-5030
Practice Address - Fax:318-388-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1448494Medicaid