Provider Demographics
NPI:1821430869
Name:WEST FELICIANA PARISH HOSPITAL PEDIATRIC CLINIC
Entity Type:Organization
Organization Name:WEST FELICIANA PARISH HOSPITAL PEDIATRIC CLINIC
Other - Org Name:WFPH PEDIATRIC CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LADOUX
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHASTANT
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:225-635-3811
Mailing Address - Street 1:PO BOX 1219
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-1219
Mailing Address - Country:US
Mailing Address - Phone:225-635-9065
Mailing Address - Fax:225-635-9069
Practice Address - Street 1:10273 GOULD DRIVE
Practice Address - Street 2:650
Practice Address - City:SAINT FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775-1219
Practice Address - Country:US
Practice Address - Phone:225-635-9065
Practice Address - Fax:225-635-9069
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST FELICIANA PARISH HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty