Provider Demographics
NPI: | 1821090713 |
---|---|
Name: | CHILDRENS HOSPITAL MEDICAL PRACTICE CORPORATION |
Entity Type: | Organization |
Organization Name: | CHILDRENS HOSPITAL MEDICAL PRACTICE CORPORATION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | NICOLE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LABORDE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 504-896-2861 |
Mailing Address - Street 1: | 298 HENRY CLAY AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW ORLEANS |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 70118-5720 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 504-896-9827 |
Mailing Address - Fax: | 504-894-5370 |
Practice Address - Street 1: | 298 HENRY CLAY AVE |
Practice Address - Street 2: | |
Practice Address - City: | NEW ORLEANS |
Practice Address - State: | LA |
Practice Address - Zip Code: | 70118-5720 |
Practice Address - Country: | US |
Practice Address - Phone: | 504-896-9827 |
Practice Address - Fax: | 504-894-5370 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | LOUISIANA CHILDREN'S MEDICAL CENTER |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2005-08-11 |
Last Update Date: | 2023-04-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2080A0000X | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | Group - Multi-Specialty |
No | 2080C0008X | Allopathic & Osteopathic Physicians | Pediatrics | Child Abuse Pediatrics | Group - Multi-Specialty |
No | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | Group - Multi-Specialty |
No | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics | Group - Multi-Specialty |
No | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | Group - Multi-Specialty |
No | 2080P0208X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases | Group - Multi-Specialty |
No | 2080P0216X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Rheumatology | Group - Multi-Specialty |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
No | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | Group - Multi-Specialty |
No | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
LA | 1946711 | Medicaid | |
LA | 1946711 | Medicaid |