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SOUTHERN PEDIATRIC CLINIC
NPI 1104297720
Clinic/Center - Health Service in Shreveport, LA

Active since October 08, 2015
202 N THOMAS DR, SUITE 1, SHREVEPORT, LA 71107(318) 221-0277(318) 221-3277 Get Directions Write a Review

NPPES record last updated: November 3, 2015. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Southern Pediatric Clinic NPPES

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

SOUTHERN PEDIATRIC CLINIC (NPI 1104297720) is a healthcare organization registered as a health service in Shreveport, Louisiana and active in the NPI registry since October 2015. The organization lists Stella Grace Immanuel, Owner, as its authorized official.

NPPES Registry Identity

NPI1104297720
Entity TypeOrganization
Primary Taxonomy261QH0100X
Legal Business NameSOUTHERN PEDIATRIC CLINIC
Location Address202 N THOMAS DR, SUITE 1Shreveport, LA 71107-6539
Mailing Address202 N Thomas Dr, Suite 1Shreveport, LA 71107-6539 · (318) 221-0277 · Fax (318) 221-3277
Phone(318) 221-0277
Fax(318) 221-3277
Organization SubpartNo
Authorized OfficialStella Grace ImmanuelOwner · (318) 221-0277
Enumeration DateOctober 8, 2015
Last NPPES UpdateNovember 3, 2015
✔ NPI 1104297720 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
202 N THOMAS DR, Shreveport, LA 71107
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Other Identifiers 1

Medicaid1449237LA

Other Providers at the Same Location NPPES

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

SOUTHERN PEDIATRIC CLINIC
Clinic/Center (Primary Care)
202 N THOMAS DR, SUITE 1
SHREVEPORT, LA 71107
Caddo Parish (318) 221-0277

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 1104297720. It was assigned to this organization in the NPPES registry on October 8, 2015.

Where is Southern Pediatric Clinic located?

Southern Pediatric Clinic is located at 202 N Thomas Dr Suite 1, Shreveport, LA 71107. The listed phone number is (318) 221-0277.

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.