Provider Demographics
NPI:1467135756
Name:OAKDALE CHILDRENS CLINIC
Entity Type:Organization
Organization Name:OAKDALE CHILDRENS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-481-3077
Mailing Address - Street 1:211 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-2211
Mailing Address - Country:US
Mailing Address - Phone:318-817-1064
Mailing Address - Fax:318-817-1065
Practice Address - Street 1:211 N 16TH ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-2211
Practice Address - Country:US
Practice Address - Phone:318-817-1064
Practice Address - Fax:318-817-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty