Provider Demographics
NPI:1245231026
Name:PEARL ACRES PEDIATRICS LLC
Entity Type:Organization
Organization Name:PEARL ACRES PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:OERTLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-643-7927
Mailing Address - Street 1:59125 N PEARL DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-3727
Mailing Address - Country:US
Mailing Address - Phone:985-643-7927
Mailing Address - Fax:985-641-0209
Practice Address - Street 1:59125 N PEARL DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-3727
Practice Address - Country:US
Practice Address - Phone:985-643-7927
Practice Address - Fax:985-641-0209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1442178Medicaid