Pediatrust Hattiesburg

Primary specialty

Pediatric Skilled Nursing FacilityTaxonomy code 3140N1450X

License

1902256191 Issued in MS

Legal business name

PEDIATRUST HATTIESBURG

Practice address

6270 Sevenoaks Ave
Baton Rouge, LA 70806-7330

Phone

(225) 252-7633

NPI assigned

Jun 17, 2016

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": "1466121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483401600000",
    "number": "1902256191",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6270 SEVENOAKS AVE",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708067330",
            "telephone_number": "225-252-7633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRUST HATTIESBURG",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-17",
        "last_updated": "2017-01-03",
        "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": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": "MS",
            "license": "1902256191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "475088111",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pediatric Services of America, LLC
• Pediatric Solutions
• Pediatric Surgery of Louisiana, LLC
• Pediatric Therapy Group LLC
• Pediatrust Baton Rouge, LLC
• Carol Rust Peebles, M.D.
• Jane Barclay Peek, MD
• Sir-Raheem Tyrese Peeler
• Peer Plus, LLC
• Peer4Peer

• Pediatric Skilled Nursing Facility in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Pediatric Skilled Nursing Facility in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2017; 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.