Provider Demographics
NPI:1689847956
Name:SHAHID MANSOOR, MD. A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SHAHID MANSOOR, MD. A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:HEALTHY STEPS PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:RACHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-484-3899
Mailing Address - Street 1:192 STILLEY RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5933
Mailing Address - Country:US
Mailing Address - Phone:318-484-3401
Mailing Address - Fax:318-484-3402
Practice Address - Street 1:192 STILLEY RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5933
Practice Address - Country:US
Practice Address - Phone:318-484-3401
Practice Address - Fax:318-484-3402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAHID MANSOOR, M.D. (A PROFESSIONAL MEDICAL CORPORATION)
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-08
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty