Provider Demographics
NPI:1649715079
Name:THE PERKINS PEDIATRIC CLINIC, LLC
Entity type:Organization
Organization Name:THE PERKINS PEDIATRIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:T
Authorized Official - Last Name:ALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:337-462-6000
Mailing Address - Street 1:614 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-3546
Mailing Address - Country:US
Mailing Address - Phone:337-462-6000
Mailing Address - Fax:337-462-6560
Practice Address - Street 1:614 N PINE ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-3546
Practice Address - Country:US
Practice Address - Phone:337-462-6000
Practice Address - Fax:337-462-6560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14134R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2482530Medicaid
LA1181137Medicaid