Provider Demographics
NPI:1255540506
Name:ALL KIDS PEDIATRICS OF OPELOUSAS
Entity type:Organization
Organization Name:ALL KIDS PEDIATRICS OF OPELOUSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SINGLETON-BEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-407-8697
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-2147
Mailing Address - Country:US
Mailing Address - Phone:337-407-8697
Mailing Address - Fax:337-407-9096
Practice Address - Street 1:920 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570
Practice Address - Country:US
Practice Address - Phone:337-407-8697
Practice Address - Fax:337-407-9096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022773291U00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1493058Medicaid
LA1449482Medicaid
LA1493058Medicaid