Pediatrust Lake Charles, LLC

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

2203782281 Issued in LA

Legal business name

PEDIATRUST LAKE CHARLES, LLC

Practice address

4250 5TH Ave
Lake Charles, LA 70607-3900

Phone

(337) 562-7818

NPI assigned

Feb 19, 2015

Organization subpart

No

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

Authorized official

Name

Leann Craig

Title

Owner

Phone

(225) 252-7633

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1424304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424304000000",
    "number": "1518359165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6270 SEVENOAKS AVE",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708067330",
            "telephone_number": "225-252-7633",
            "fax_number": "337-214-2061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4250 5TH AVE",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706073900",
            "telephone_number": "337-562-7818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRUST LAKE CHARLES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-19",
        "last_updated": "2015-02-19",
        "status": "A",
        "authorized_official_last_name": "CRAIG",
        "authorized_official_first_name": "LEANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "225-252-7633"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "LA",
            "license": "2203782281",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2203782281",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Todd Allen Peavy, MD
• Shreyas Venkat Peddigari, MD
• Alana Christine Peden, LPN
• Pediatric Cardiology of Southwest Louisiana, LLC
• Pediatric Therapy of Louisiana
• Colton Don Peebles, B.C.B.A., L.B.A.
• Levince Oliver Peeples, LPN
• Claire Theresa Pellerin, L.P.C., L.M.F.T.
• Roxanne Peltier
• Hannah Pennick, FNP-C

• Exclusive Provider Organization in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Exclusive Provider Organization in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2015; 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.