Provider Demographics
NPI:1629105416
Name:PEDIATRIC HEALTH ASSOCIATES, L.L.C.
Entity Type:Organization
Organization Name:PEDIATRIC HEALTH ASSOCIATES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:HEDGEMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-925-2055
Mailing Address - Street 1:624 CHEVELLE CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6502
Mailing Address - Country:US
Mailing Address - Phone:225-925-2055
Mailing Address - Fax:225-925-2142
Practice Address - Street 1:624 CHEVELLE CT
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6502
Practice Address - Country:US
Practice Address - Phone:225-925-2055
Practice Address - Fax:225-925-2142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06831R208000000X
LARN032514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1689664104OtherINDIVIDUAL NPI FOR NP
LA1449245Medicaid
LA1487681359OtherINDIVIDUAL NPI FOR DR