Provider Demographics
NPI:1235397159
Name:CHILDREN & ADOLESCENT CLINIC
Entity Type:Organization
Organization Name:CHILDREN & ADOLESCENT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PADMINI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-643-8400
Mailing Address - Street 1:801 N MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:KAPLAN
Mailing Address - State:LA
Mailing Address - Zip Code:70548-2007
Mailing Address - Country:US
Mailing Address - Phone:337-643-8400
Mailing Address - Fax:337-643-1544
Practice Address - Street 1:801 N MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:KAPLAN
Practice Address - State:LA
Practice Address - Zip Code:70548-2007
Practice Address - Country:US
Practice Address - Phone:337-643-8400
Practice Address - Fax:337-643-1544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.05415R261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1316989Medicaid