Provider Demographics
NPI:1295954857
Name:J.P. ROSALES, K.R. MALMAY & M.P. O'BOYLE DBA CHILDREN'S HOSPITAL CARE
Entity type:Organization
Organization Name:J.P. ROSALES, K.R. MALMAY & M.P. O'BOYLE DBA CHILDREN'S HOSPITAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:K
Authorized Official - Middle Name:R
Authorized Official - Last Name:MALMAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-329-8181
Mailing Address - Street 1:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71210-1325
Mailing Address - Country:US
Mailing Address - Phone:318-329-8181
Mailing Address - Fax:318-329-8183
Practice Address - Street 1:104 CONTEMPO AVE
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5312
Practice Address - Country:US
Practice Address - Phone:318-329-8181
Practice Address - Fax:318-329-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1945234Medicaid