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

Last updated

Jul 12, 2007By 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. 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, and the practitioner matching its NPPES authorized official.

• Elisabeth Jones Haller, MD

  • Pediatrics Physician
  • Biloxi, MS
  • NPI 1679679864
  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": "",
            "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 MRI)
• Cedar Lake Pharmacy (Lee Pharmacy)
• Cedar Lake Pharmacy (Cedar Lake Pharmacy LLC.)
• Centerwell Senior Primary Care Ms CS PC
• Centerwell Senior Primary Care Ms PC (CenterWell Senior Primary Care-Biloxi)
• Aubri Challis

• Pediatrics Physician in Biloxi, MS
• Providers in Biloxi, MS by specialty
• 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.