Provider Demographics
NPI:1871670752
Name:CENLA CHILDREN'S CLINIC & ASSOCIATES
Entity Type:Organization
Organization Name:CENLA CHILDREN'S CLINIC & ASSOCIATES
Other - Org Name:PINEVILLE CHILDREN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:C
Authorized Official - Middle Name:V
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-487-1358
Mailing Address - Street 1:501 MEDICAL CENTER DR # 30140 SUITE 100
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8124
Mailing Address - Country:US
Mailing Address - Phone:318-487-1358
Mailing Address - Fax:318-487-9584
Practice Address - Street 1:501 MEDICAL CENTER DR # 30140 SUITE 100
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8124
Practice Address - Country:US
Practice Address - Phone:318-487-1358
Practice Address - Fax:318-487-9584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1740283852OtherDR. DANIVAS NPI#
LA1682152Medicaid
LA1196371Medicaid
LA1053314187OtherDR. BHARGAVA'S NPI#
LA1435775Medicaid
LA1730182866OtherDR REDDY'S NPI#
LAG31901Medicare UPIN
LA1682152Medicaid