Basic Information
| Provider Information | |||||||||
| NPI: | 1467602755 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDRENS ACUTE CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1333 N BUFFALO DR | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891283636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023957095 | ||||||||
| FaxNumber: | 7023953502 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 SAINT MARY PL | ||||||||
| Address2: | BOX 40 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711014343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186816433 | ||||||||
| FaxNumber: | 3186816448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2008 | ||||||||
| LastUpdateDate: | 02/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | GIOIA | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7023957095 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0204X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 176930002 | 05 | AR | MEDICAID | 1321664 | 05 | LA | MEDICAID | 196704401 | 05 | TX | MEDICAID |