| NPI | 1073969531 |
|---|---|
| Former Legal Business Name | LILY PAD PEDIATRICS, LLC |
| Entity Type | Organization |
| Authorized Contact | JACKIE CLARK Billing Manager 337-942-4453 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2024-04-02 |