Organization
PEDIATRIC PROVIDERS OF LOUISIANA
Active
Organization
PEDIATRIC PROVIDERS OF LOUISIANA
Active
Other names
Mooretown Family Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN ROUSSEAU (PRESIDENT)
(318) 621-9600
Entity
Organization
Contact information
Practice address
4140 HOLLYWOOD AVE, SHREVEPORT, LA 71109-7818
(318) 621-9600
(318) 621-0169
Mailing address
4140 HOLLYWOOD AVE, SHREVEPORT, LA 71109-7818
(318) 621-9600
(318) 621-0169
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
06203R
LA
Other
Enumeration date
05/05/2009
Last updated
08/21/2009
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