Provider Demographics
NPI:1598983637
Name:CHILDREN'S CLINIC
Entity Type:Organization
Organization Name:CHILDREN'S CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:WINTERTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-797-6601
Mailing Address - Street 1:1819 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5301
Mailing Address - Country:US
Mailing Address - Phone:318-797-6601
Mailing Address - Fax:318-797-5999
Practice Address - Street 1:1819 E 70TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5301
Practice Address - Country:US
Practice Address - Phone:318-797-6601
Practice Address - Fax:318-797-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty