| Professional Pediatrics, Llc | |
|
919 S 10th St Leesville LA 71446-4613 | |
| (337) 239-2207 | |
| Not Available |
| Full Name | Professional Pediatrics, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 919 S 10th St, Leesville, Louisiana |
| Authorized Official Name and Position | Robert Crowe (PHYSICIAN) |
| Authorized Official Contact | 3372380777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Pediatrics, Llc Po Box 130 Newllano LA 71461-0130 Ph: () - | Professional Pediatrics, Llc 919 S 10th St Leesville LA 71446-4613 Ph: (337) 239-2207 |
| NPI Number | 1376717959 |
|---|---|
| Provider Enumeration Date | 04/15/2008 |
| Last Update Date | 07/21/2020 |
| Medicare PECOS PAC ID | 5698847317 |
|---|---|
| Medicare Enrollment ID | O20080711000328 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376717959 | NPI | - | NPPES |
| 2114841 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Robert F Crowe |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1790774958 PECOS PAC ID: 0244233161 Enrollment ID: I20060815000401 |
| Provider Name | Jennifer Lee Cooley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982185799 PECOS PAC ID: 1658617907 Enrollment ID: I20190108002694 |
| Provider Name | Heather M Daniels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598280810 PECOS PAC ID: 5890023717 Enrollment ID: I20190829002808 |
| Provider Name | Tracy Jacobs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750877825 PECOS PAC ID: 3779812219 Enrollment ID: I20190910000578 |
| Provider Name | Jana N Lambert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447500293 PECOS PAC ID: 1658704150 Enrollment ID: I20191213000109 |
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