Organization
SOUTHERN PEDIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STELLA GRACE IMMANUEL MD (OWNER)
(318) 215-8150
Entity
Organization
Contact information
Practice address
905 E 7TH AVE, SUITE 9, OAKDALE, LA 71463-2797
(318) 215-8150
(318) 215-8151
Mailing address
905 E 7TH AVE, SUITE 9, OAKDALE, LA 71463-2797
(318) 215-8150
(318) 215-8151
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
MD12866R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1449237
—
LA
Enumeration date
09/29/2015
Last updated
11/03/2015
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us