Provider Demographics
NPI:1912165341
Name:CHILDRENS HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:CHILDRENS HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:H
Authorized Official - Last Name:PULLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-550-1175
Mailing Address - Street 1:3521 HIGHWAY 190 STE N
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-5135
Mailing Address - Country:US
Mailing Address - Phone:337-550-1175
Mailing Address - Fax:337-550-1176
Practice Address - Street 1:3521 HIGHWAY 190 STE N
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5135
Practice Address - Country:US
Practice Address - Phone:337-550-1175
Practice Address - Fax:337-550-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022507208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1183709Medicaid
LA1183709Medicaid