Organization
PEDIATRIC CLINIC OF LAFAYETTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. USHA KRISHNAMOORTHY RHIA, CCS-P (BILLING OFFICE)
(337) 322-6673
Entity
Organization
Contact information
Practice address
104 GENEVIEVE DR, LAFAYETTE, LA 70503-4811
(337) 984-0110
(337) 981-7210
Mailing address
104 GENEVIEVE DR, LAFAYETTE, LA 70503-4811
(337) 984-0110
(337) 981-7210
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2138332
—
LA
Enumeration date
10/18/2021
Last updated
10/18/2021
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