| Fertile Crescent Pediatrics, Llc | |
|
730 Colonial Dr Suite B Baton Rouge LA 70806-6536 | |
| (225) 924-7343 | |
| (225) 924-7347 |
| Full Name | Fertile Crescent Pediatrics, Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 730 Colonial Dr, Baton Rouge, Louisiana |
| Authorized Official Name and Position | Brian Despinasse (CEO) |
| Authorized Official Contact | 2259247343 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fertile Crescent Pediatrics, Llc 730 Colonial Dr Suite B Baton Rouge LA 70806-6536 Ph: (225) 924-7343 | Fertile Crescent Pediatrics, Llc 730 Colonial Dr Suite B Baton Rouge LA 70806-6536 Ph: (225) 924-7343 |
| NPI Number | 1902131667 |
|---|---|
| Provider Enumeration Date | 10/13/2009 |
| Last Update Date | 10/13/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902131667 | NPI | - | NPPES |
| 1490903 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 023350 (Louisiana) | Primary |
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