Abc Pediatrics
Organization Active NPI Specialist · Minden, LA
NPI 1285080358 · NPPES record last updated Feb 28, 2022
Key facts
- NPI
- 1285080358
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- License
- 204591 (LA)
- Legal business name
- ABC PEDIATRICS
- Practice address
- 164 Country Club Circle Ste. B
Minden, LA 71055 - Phone
- (318) 639-9422
- Fax
- (318) 639-9423
- NPI assigned
- May 9, 2016
- Organization subpart
- No
Authorized official
- Name
- Dr. Cristal Kirby, MD
- Title
- Owner
- Phone
- (318) 639-9422
Practitioners 2
-
Cristal Chanel Kirby, M.D.
-
Ginger A Roberts, NP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 19D2112167 | Abc Pediatrics, LLC | Certificate of waiver | Apr 24, 2028 |
National Provider Directory
Locations
164 Country Club Cir
Minden, LA 71055
Phone (318) 639-9559
Interoperability endpoints
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.105596
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | 204591 | LA | Yes |
Addresses
Primary practice location
164 Country Club Circle Ste. B
Minden, LA 71055
Mailing address
164 Country Club Circle
Minden, LA 71055
Phone (318) 639-9422
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2155717 | Medicaid | LA |
Other providers in Minden, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.