Provider Demographics
NPI:1023067899
Name:SHALOM CLINIC FOR CHILDREN RHC INC
Entity type:Organization
Organization Name:SHALOM CLINIC FOR CHILDREN RHC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OLABISI
Authorized Official - Middle Name:O
Authorized Official - Last Name:OSHIKANLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-628-5518
Mailing Address - Street 1:609 W COURT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-2633
Mailing Address - Country:US
Mailing Address - Phone:318-628-5518
Mailing Address - Fax:
Practice Address - Street 1:609 W COURT ST
Practice Address - Street 2:SUITE B
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-2633
Practice Address - Country:US
Practice Address - Phone:318-648-5518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1008524Medicaid
LA19-3877Medicare PIN