Provider Demographics
NPI:1891957593
Name:CHILD AND ADOLESCENT CLINIC OF CROWLEY
Entity Type:Organization
Organization Name:CHILD AND ADOLESCENT CLINIC OF CROWLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:S.
Authorized Official - Middle Name:SANGEETA
Authorized Official - Last Name:KRISHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-783-6857
Mailing Address - Street 1:1307 CROWLEY RAYNE HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-8210
Mailing Address - Country:US
Mailing Address - Phone:337-783-6857
Mailing Address - Fax:337-783-6167
Practice Address - Street 1:1307 CROWLEY RAYNE HWY
Practice Address - Street 2:SUITE B
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-8210
Practice Address - Country:US
Practice Address - Phone:337-783-6857
Practice Address - Fax:337-783-6167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD022952080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1693197Medicaid