| Children's International Medical Group | |
|
1828 W Thomas St Hammond LA 70401-2958 | |
| (985) 419-2250 | |
| (985) 419-2252 |
| Full Name | Children's International Medical Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 1828 W Thomas St, Hammond, Louisiana |
| Authorized Official Name and Position | Zach Hays Allen (VP) |
| Authorized Official Contact | 9856461580 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Children's International Medical Group 59101 Amber St Slidell LA 70461-3708 Ph: (985) 646-1580 | Children's International Medical Group 1828 W Thomas St Hammond LA 70401-2958 Ph: (985) 419-2250 |
| NPI Number | 1366946030 |
|---|---|
| Provider Enumeration Date | 03/19/2018 |
| Last Update Date | 03/19/2018 |
| Medicare PECOS PAC ID | 1254633308 |
|---|---|
| Medicare Enrollment ID | O20171208001817 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366946030 | NPI | - | NPPES |
| 1020303 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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