Provider Demographics
NPI:1326146499
Name:CRESCENT CITY PEDIATRICS, L.L.C.
Entity Type:Organization
Organization Name:CRESCENT CITY PEDIATRICS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-486-5151
Mailing Address - Street 1:320 N CARROLLTON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5144
Mailing Address - Country:US
Mailing Address - Phone:504-486-5151
Mailing Address - Fax:
Practice Address - Street 1:320 N CARROLLTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5144
Practice Address - Country:US
Practice Address - Phone:504-486-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1442518Medicaid