Provider Demographics
NPI:1356508188
Name:LOUDON PEDIATRIC CLINIC PC
Entity Type:Organization
Organization Name:LOUDON PEDIATRIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:GUIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-458-5666
Mailing Address - Street 1:616 WARD AVE
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-1323
Mailing Address - Country:US
Mailing Address - Phone:865-458-5666
Mailing Address - Fax:865-458-9906
Practice Address - Street 1:616 WARD AVE
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1323
Practice Address - Country:US
Practice Address - Phone:865-458-5666
Practice Address - Fax:865-458-9906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12939208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1503978Medicaid
TN3183016Medicaid