Provider Demographics
NPI:1114020542
Name:VILLE PLATTE PEDIATRICS PA
Entity Type:Organization
Organization Name:VILLE PLATTE PEDIATRICS PA
Other - Org Name:VILLE PLATTE PEDIATRICS CORP
Other - Org Type:Other Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DODANIM
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:ALTAMIRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-363-3560
Mailing Address - Street 1:504 JACK MILLER ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586
Mailing Address - Country:US
Mailing Address - Phone:337-363-3560
Mailing Address - Fax:337-363-3507
Practice Address - Street 1:504 JACK MILLER ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586
Practice Address - Country:US
Practice Address - Phone:337-363-3560
Practice Address - Fax:337-363-3507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11525R208000000X
LA193914261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA241402006OtherCONTROLLED DANG SUB
LA1671177Medicaid
BA2799320OtherDEA
F24238Medicare UPIN
LA241402006OtherCONTROLLED DANG SUB