Provider Demographics
NPI:1407858566
Name:THE CENTER FOR PEDIATRIC AND ADOLESCENT MEDICINE,LLC
Entity Type:Organization
Organization Name:THE CENTER FOR PEDIATRIC AND ADOLESCENT MEDICINE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:TOUPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-448-3700
Mailing Address - Street 1:604 N ACADIA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4897
Mailing Address - Country:US
Mailing Address - Phone:985-448-3700
Mailing Address - Fax:985-448-3900
Practice Address - Street 1:604 N ACADIA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4897
Practice Address - Country:US
Practice Address - Phone:985-448-3700
Practice Address - Fax:985-448-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1948446Medicaid