Basic Information
| Provider Information | |||||||||
| NPI: | 1922543446 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDREN'S INTERNATIONAL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 59101 AMBER ST | ||||||||
| Address2: | |||||||||
| City: | SLIDELL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704613708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856461580 | ||||||||
| FaxNumber: | 9856461579 | ||||||||
| Practice Location | |||||||||
| Address1: | 702 S 1ST ST | ||||||||
| Address2: | |||||||||
| City: | AMITE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704223404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9852472411 | ||||||||
| FaxNumber: | 8448563736 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2016 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | ZIERHUT | ||||||||
| AuthorizedOfficialFirstName: | LINDSEY | ||||||||
| AuthorizedOfficialMiddleName: | THOMAS | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF MEDICAL STAFF AFFAIRS | ||||||||
| AuthorizedOfficialTelephone: | 9856461580 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.