| Louisiana Internal Medicine And Pediatric Associates, Llc | |
|
7150 Jefferson Hwy Baton Rouge LA 70806-8128 | |
| (225) 216-7885 | |
| (225) 216-7886 |
| Full Name | Louisiana Internal Medicine And Pediatric Associates, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7150 Jefferson Hwy, Baton Rouge, Louisiana |
| Authorized Official Name and Position | Kenyatta Shamlin-haynes (PART OWNER) |
| Authorized Official Contact | 2254056381 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Louisiana Internal Medicine And Pediatric Associates, Llc 7150 Jefferson Hwy Baton Rouge LA 70806-8128 Ph: (225) 216-7885 | Louisiana Internal Medicine And Pediatric Associates, Llc 7150 Jefferson Hwy Baton Rouge LA 70806-8128 Ph: (225) 216-7885 |
| NPI Number | 1871025387 |
|---|---|
| Provider Enumeration Date | 04/03/2017 |
| Last Update Date | 04/03/2017 |
| Medicare PECOS PAC ID | 5092089896 |
|---|---|
| Medicare Enrollment ID | O20170918001571 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871025387 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | LA025911 (Louisiana) | Primary |
| Provider Name | Kenyatta Shamlin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093712234 PECOS PAC ID: 8123128857 Enrollment ID: I20101020000040 |
| Provider Name | Tasha C Shamlin |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1568468296 PECOS PAC ID: 5496855124 Enrollment ID: I20101020001345 |
| Provider Name | Adravon S Henderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326408576 PECOS PAC ID: 4587943014 Enrollment ID: I20161128000760 |
| Provider Name | Shamelle Beaulieu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306369616 PECOS PAC ID: 2466710421 Enrollment ID: I20171220001338 |
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