Provider Demographics
NPI:1588968994
Name:PATRICIA M SCHNEIDER MD PEDATRIC CLINIC, LLC
Entity type:Organization
Organization Name:PATRICIA M SCHNEIDER MD PEDATRIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-635-9065
Mailing Address - Street 1:PO BOX 1219
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-1219
Mailing Address - Country:US
Mailing Address - Phone:225-635-9065
Mailing Address - Fax:225-635-9069
Practice Address - Street 1:10273 GOULD DRIVE
Practice Address - Street 2:
Practice Address - City:SAINT FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775-0487
Practice Address - Country:US
Practice Address - Phone:225-635-9065
Practice Address - Fax:225-635-9069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012764208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2152815Medicaid
LAB89696OtherUPIN
LA1168572Medicaid