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SOUTHERN PEDIATRIC CLINIC
NPI 1104296417
Clinic/Center - Health Service in Oakdale, LA

Active since September 29, 2015
905 E 7TH AVE, SUITE 9, OAKDALE, LA 71463(318) 215-8150(318) 215-8151 Get Directions Write a Review

NPPES record last updated: November 3, 2015. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Southern Pediatric Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHERN PEDIATRIC CLINIC (NPI 1104296417) is a healthcare organization registered as a health service in Oakdale, Louisiana and active in the NPI registry since September 2015. The organization lists Stella Grace Immanuel, Owner, as its authorized official.

NPPES Registry Identity

NPI1104296417
Entity TypeOrganization
Primary Taxonomy261QH0100X
Legal Business NameSOUTHERN PEDIATRIC CLINIC
Location Address905 E 7TH AVE, SUITE 9Oakdale, LA 71463-2797
Mailing Address905 E 7th Ave, Suite 9Oakdale, LA 71463-2797 · (318) 215-8150 · Fax (318) 215-8151
Phone(318) 215-8150
Fax(318) 215-8151
Organization SubpartNo
Authorized OfficialStella Grace ImmanuelOwner · (318) 215-8150
Enumeration DateSeptember 29, 2015
Last NPPES UpdateNovember 3, 2015
✔ NPI 1104296417 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Health ServiceAmbulatory Health Care Facilities
Taxonomy Code261QH0100X
License✔ Licensed in LA · MD12866R
905 E 7TH AVE, Oakdale, LA 71463
Open in Google Maps ↗

Other Identifiers 1

Medicaid1449237LA

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. TABATHA ARIEL HUDSPETH
Case Manager/Care Coordinator
905 E 7TH AVE
OAKDALE, LA 71463
Allen Parish (318) 335-1048
MRS. JAMIE GOUDEAU
Counselor (Mental Health)
905 E 7TH AVE
OAKDALE, LA 71463
Allen Parish (318) 335-1048
LAFLEUR EYE CLINIC LLC
Optometrist
905 E 7TH AVE, SUITE 2
OAKDALE, LA 71463
Allen Parish (337) 281-8226

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southern Pediatric Clinic's NPI number?

The NPI number for Southern Pediatric Clinic is 1104296417. It was assigned to this organization in the NPPES registry on September 29, 2015.

Where is Southern Pediatric Clinic located?

Southern Pediatric Clinic is located at 905 E 7th Ave Suite 9, Oakdale, LA 71463. The listed phone number is (318) 215-8150.

What is Southern Pediatric Clinic's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Health Service, with taxonomy code 261QH0100X.

When was this NPI record last updated?

The NPPES record for Southern Pediatric Clinic was last updated on November 3, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.