Provider Demographics
NPI:1346895638
Name:STRAWBERRY PATCH PEDIATRICS LLC
Entity Type:Organization
Organization Name:STRAWBERRY PATCH PEDIATRICS LLC
Other - Org Name:STRAWBERRY PATCH PEDIATRICS & FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:225-278-7691
Mailing Address - Street 1:1054 SW RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-3557
Mailing Address - Country:US
Mailing Address - Phone:855-869-9898
Mailing Address - Fax:985-401-9898
Practice Address - Street 1:1054 SW RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-3557
Practice Address - Country:US
Practice Address - Phone:855-869-9898
Practice Address - Fax:985-401-9898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty