SOUTHERN PEDIATRIC CLINIC (NPI# 1508237256) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508237256 |
| Entity Type | Organization |
| Organization Name | SOUTHERN PEDIATRIC CLINIC |
| Practice Address |
4571 N Market St Shreveport LA 71107-2917 |
| Practice Telephone | 3189340097 |
| Mailing Telephone | 3189340097 |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2015-10-07 |
| Authorized Official Name | STELLA GRACE IMMANUEL (MD) |
| Authorized Official Telephone | 3187309760 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
MD12866R | LA | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104297720 | Southern Pediatric Clinic | Clinic/Center | 202 N Thomas Dr, Suite 1, Shreveport, LA 71107-6539 | 2015-10-08 |
| 1487766804 | Southern Pediatric Clinic | Pediatrics | 1416 Metro Dr, Alexandria, LA 71301-3424 | 2006-08-31 |
| 1528432440 | Southern Pediatric Clinic | Clinic/Center | 202 N Thomas Dr, Suite 1, Shreveport, LA 71107-6539 | 2015-11-16 |
| 1104296417 | Southern Pediatric Clinic | Clinic/Center | 905 E 7th Ave, Suite 9, Oakdale, LA 71463-2797 | 2015-09-29 |
| Street Address |
4571 N MARKET ST |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71107-2917 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336168020 | Catrell J. Mcculloch | Pediatrics | 4571 N Market St, Shreveport, LA 71107-2917 | 2006-07-19 |
| 1710525738 | Tierra Demming | Case Manager/Care Coordinator | 4571 N Market St, Shreveport, LA 71107-2917 | 2019-12-20 |
| 1326699208 | Shamkea Dixon | Case Manager/Care Coordinator | 4571 N Market St, Shreveport, LA 71107-2917 | 2019-09-23 |
| 1659922524 | Johnna Williams | Case Manager/Care Coordinator | 4571 N Market St, Shreveport, LA 71107-2917 | 2019-09-23 |
| 1245889138 | Niara Talton | Case Manager/Care Coordinator | 4571 N Market St, Shreveport, LA 71107-2917 | 2019-09-04 |
| 1770135626 | Kadavion Evans | Case Manager/Care Coordinator | 4571 N Market St, Shreveport, LA 71107-2917 | 2019-07-11 |
| 1548824493 | Pam Peters | Case Manager/Care Coordinator | 4571 N Market St, Shreveport, LA 71107-2917 | 2019-04-25 |
| 1275197121 | Demetrial Houston | Case Manager/Care Coordinator | 4571 N Market St, Shreveport, LA 71107-2917 | 2019-04-25 |
| 1326499922 | Teriana Pierre | Social Worker | 4571 N Market St, Shreveport, LA 71107-2917 | 2016-06-24 |
| 1528415783 | Yomeka M Evans | Case Manager/Care Coordinator | 4571 N Market St, Shreveport, LA 71107-2917 | 2016-05-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306490875 | Kimber Leigh Lumley | Registered Nurse | 1440 Hawn Ave., Shreveport, LA 71107 | 2019-08-01 |
| 1871063461 | Nicole Capito | Case Manager/Care Coordinator | 200 North Thomas Drive Ste 1, Shreveport, LA 71107 | 2018-11-27 |
| 1891260899 | Danielle Leigh Dreher | Dental Assistant | 3610 Gorman Rd, Shreveport, LA 71107 | 2018-10-05 |
| 1255817540 | Shirley Marie Washington | Technician | 3227 Old Mooringsport Rd., Shreveport Rd, LA 71107 | 2018-07-19 |
| 1366928467 | Katrina L Bailey | Case Manager/Care Coordinator | 1111 Hawn Ave Apt A, Shreveport, LA 71107 | 2018-07-12 |
| 1063907970 | James Mcneely IIi | Public Health or Welfare | 5922 Alaska Ln, Shreveport, LA 71107 | 2018-06-25 |
| 1528560067 | Jacarie Guice | Case Manager/Care Coordinator | 4601 N. Market Ste 2, Shreveport, LA 71107 | 2018-03-01 |
| 1467971069 | Tracy Renard Harris | Counselor | 1149 Englemeade Dr, Shreveport, LA 71107 | 2017-09-14 |
| 1427588045 | Mark Rogers | Behavior Technician | 1500 N. Market Unit C Suite 105, Shreveport, LA 71107 | 2017-06-15 |
| 1356871164 | Hope4youth | Voluntary or Charitable | 2850 King Oaks Loop, Shreveport, LA 71107 | 2017-06-14 |
| Find all providers in zip 71107 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205457645 | Perfect Phyzique Wellness & Body Contouring, LLC | Clinic/Center | 220 Carroll St Ste A, Shreveport, LA 71105-4247 | 2020-04-27 |
| 1649328030 | Mills Clinic A Professional Medical Corporation | Clinic/Center | 7225 Fern Avenue, Suite 600, Shreveport, LA 71105-4981 | 2007-01-08 |
| 1639798291 | Sick Day Rx LLC | Clinic/Center | 817 Ardennes Ct, Shreveport, LA 71115-4613 | 2020-04-14 |
| 1376191627 | Integrity Family Medicine Clinic LLC | Clinic/Center | 1800 Buckner St Ste A120, Shreveport, LA 71101-4440 | 2019-08-29 |
| 1316418288 | Drg Medical LLC | Clinic/Center | 1549 Elizabeth Ave, Shreveport, LA 71101-4501 | 2018-12-17 |
| 1275075129 | Neil Halim Fairfield Family Clinic | Clinic/Center | 1860 Fairfield Ave, Shreveport, LA 71101-4431 | 2016-11-09 |
| 1952761686 | Jonah Healthcare, A Professional Medical Corporation | Clinic/Center | 2328 Line Ave, Shreveport, LA 71104-2131 | 2016-02-23 |
| 1528432440 | Southern Pediatric Clinic | Clinic/Center | 202 N Thomas Dr, Suite 1, Shreveport, LA 71107-6539 | 2015-11-16 |
| 1649644675 | Sarah C Hamauei, Md, LLC | Clinic/Center | 2133 E Bert Kouns Industrial Loop, Shreveport, LA 71105-5314 | 2015-11-13 |
| 1992111793 | Arterberry Family Care Center | Clinic/Center | 865 Olive St, Shreveport, LA 71104-2136 | 2014-07-01 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71107 |
Please comment or provide details below to improve the information on SOUTHERN PEDIATRIC CLINIC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.