Provider Demographics
NPI:1497880181
Name:PEDIATRIC CLINIC
Entity Type:Organization
Organization Name:PEDIATRIC CLINIC
Other - Org Name:PEDIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HILBUN-MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-926-4400
Mailing Address - Street 1:12351 INDUSTRIPLEX BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-5125
Mailing Address - Country:US
Mailing Address - Phone:225-926-4400
Mailing Address - Fax:225-926-4400
Practice Address - Street 1:12351 INDUSTRIPLEX BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-5125
Practice Address - Country:US
Practice Address - Phone:225-926-4400
Practice Address - Fax:225-926-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty