Provider Demographics
NPI:1982771663
Name:THE CHILDRENS CLINIC
Entity Type:Organization
Organization Name:THE CHILDRENS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PITRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-447-9045
Mailing Address - Street 1:807 RIDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301
Mailing Address - Country:US
Mailing Address - Phone:985-447-9045
Mailing Address - Fax:985-447-3349
Practice Address - Street 1:807 RIDGEFIELD RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301
Practice Address - Country:US
Practice Address - Phone:985-447-9045
Practice Address - Fax:985-447-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
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
LA1940739Medicaid