Provider Demographics
NPI:1801070164
Name:PEDIATRIC CLINIC OF NORTHEAST LA A MEDICAL CORPORATION
Entity type:Organization
Organization Name:PEDIATRIC CLINIC OF NORTHEAST LA A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:MEADE
Authorized Official - Last Name:O'BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-325-0483
Mailing Address - Street 1:1217 DEAN CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 LAMY LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3735
Practice Address - Country:US
Practice Address - Phone:318-387-3453
Practice Address - Fax:318-323-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty