MOORETOWN FAMILY CLINIC – NPI #1548494578
Clinic/Center

MOORETOWN FAMILY CLINIC is an AHC clinic located in SHREVEPORT, LA. NPPES has assigned the NPI number 1548494578 to MOORETOWN FAMILY CLINIC on May 05, 2009. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “MOORETOWN FAMILY CLINIC” is a dba name, the actual legal business name for this organization is PEDIATRIC PROVIDERS OF LOUISIANA. The primary taxonomy selected by this provider is 261QH0100X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Health Service

The NPI profile was previously updated about 17 years ago on Aug 21, 2009. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for MOORETOWN FAMILY CLINIC below.

NPI Profile for
PEDIATRIC PROVIDERS OF LOUISIANA

NPI Number
1548494578
Enumeration Date

(more than 17 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
PEDIATRIC PROVIDERS OF LOUISIANA
Doing Business As (dba): MOORETOWN FAMILY CLINIC
Primary location
4140 HOLLYWOOD AVE
SHREVEPORT, LA 71109-7818
Phone: (318) 621-9600 Fax: (318) 621-0169
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
JEAN ROUSSEAU
PRESIDENT
Phone: (318) 621-9600
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QH0100X
- Clinic/Center / Health Service (Primary)		 LA 06203R

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.