Cedar Lake Pediatric Clinic PLLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

CEDAR LAKE PEDIATRIC CLINIC PLLC

Practice address

1721 Medical Park Dr Ste 200
Biloxi, MS 39532-2105

Phone

(228) 248-2572

Fax

(228) 396-0687

NPI assigned

Nov 13, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Lisa J Haller, MD

Title

Owner

Phone

(228) 248-2572

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elisabeth Jones Haller, MD

  • Pediatrics Physician
  • Biloxi, MS
  • NPI 1679679864

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184198400000",
    "number": "1497826044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8873",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395358873",
            "telephone_number": "228-248-2572",
            "fax_number": "228-396-0687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 MEDICAL PARK DR STE 200",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395322105",
            "telephone_number": "228-248-2572",
            "fax_number": "228-396-0687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR LAKE PEDIATRIC CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-12",
        "status": "A",
        "authorized_official_last_name": "HALLER",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "228-248-2572",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09479561",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alkini Roycestine Catchings, KINESIOTHERAPIST
• Rene Hood Cathey, FNP
• Cedar Lake Chiropractic Inc.
• Cedar Lake Medical Center, PA
• Cedar Lake Open MRI LLC
• Cedar Lake Pharmacy
• Cedar Lake Pharmacy
• Centerwell Senior Primary Care Ms CS PC
• Centerwell Senior Primary Care Ms PC
• Aubri Challis

• All providers in Biloxi, MS
• Pediatrics Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2007; 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.