Provider Demographics
NPI:1760477798
Name:BAYOU PEDIATRIC ASSOCIATES, APMC
Entity Type:Organization
Organization Name:BAYOU PEDIATRIC ASSOCIATES, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOTINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-872-6405
Mailing Address - Street 1:8120 MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-3403
Mailing Address - Country:US
Mailing Address - Phone:985-872-6405
Mailing Address - Fax:985-872-4309
Practice Address - Street 1:8120 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3403
Practice Address - Country:US
Practice Address - Phone:985-872-6405
Practice Address - Fax:985-872-4309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1945587Medicaid