Provider Demographics
NPI:1629268396
Name:YOUNGSVILLE PEDIATRICS LLC
Entity Type:Organization
Organization Name:YOUNGSVILLE PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:U
Authorized Official - Last Name:LAURENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-857-5096
Mailing Address - Street 1:814 FORTUNE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5542
Mailing Address - Country:US
Mailing Address - Phone:337-857-5096
Mailing Address - Fax:337-857-5098
Practice Address - Street 1:814 FORTUNE RD STE 108
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5542
Practice Address - Country:US
Practice Address - Phone:337-857-5096
Practice Address - Fax:337-857-5098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13797R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1430960Medicaid
LAOTH00Medicare UPIN