Harris Memorial Pediatric Clinic, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

HARRIS MEMORIAL PEDIATRIC CLINIC, LLC

Practice address

4571 N Market St
Shreveport, LA 71107-2917

Phone

(888) 958-7561

NPI assigned

Nov 29, 2013

Last updated

Nov 29, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Catrell J McCulloch, M.D.

Title

Ceo

Phone

(888) 958-7561

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mamatha Mandava, MD

  • Pediatrics Physician
  • Shreveport, LA
  • NPI 1346568177
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385683200000",
    "number": "1285065383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4571 N MARKET ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711072917",
            "telephone_number": "888-958-7561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4571 N MARKET ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711072917",
            "telephone_number": "888-958-7561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRIS MEMORIAL PEDIATRIC CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-29",
        "last_updated": "2013-11-29",
        "status": "A",
        "authorized_official_last_name": "MCCULLOCH",
        "authorized_official_first_name": "CATRELL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "888-958-7561",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susanna H Harrel, CRNA
• Alexis Victoria Rachel Harrell
• Dylan Don Harrell, MD
• Richard M Harrell, MD
• Harris Memorial Pediatric & Family Clinic
• Sherry Harris-Boles
• Pamela Harris-Waller
• Joy Harris-Woodard, LPC
• Alan Keith Harris I
• Amber Leeann Harris

• Primary Care Clinic/Center in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Primary Care Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.