IMPACT PHYSICIAN GROUP, PEDIATRICS LLC (NPI# 1689290603) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689290603 |
| Entity Type | Organization |
| Organization Name | IMPACT PHYSICIAN GROUP, PEDIATRICS LLC |
| Practice Address |
2720 Rue De Jardin Ste 100 Lake Charles LA 70605-4050 |
| Mailing Address |
21 Eastbrook Bnd Ste 218 Peachtree City GA 30269-1546 |
| Practice Telephone | 2604078009 |
| Practice Fax Number | 2604078009 |
| Mailing Telephone | 2604078009 |
| Mailing Fax Number | 2604078009 |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2020-07-07 |
| Authorized Official Name | PAUL MILLER (CEO) |
| Authorized Official Telephone | 2604078009 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| Street Address |
2720 RUE DE JARDIN STE 100 |
| City | LAKE CHARLES |
| State | LA |
| Zip Code | 70605-4050 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437775459 | Impact Physician Group, Louisiana LLC | Internal Medicine | 2720 Rue De Jardin Ste 100, Lake Charles, LA 70605-4050 | 2020-06-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780283606 | Kristin R Morris | Clinical Nurse Specialist | 1900 W. Gaythier Rd, Lake Charles, LA 70605 | 2020-10-21 |
| 1548871577 | Jacob M Theriot | Nurse Practitioner | 2640 County Club Rd., Lake Charles, LA 70605 | 2020-08-13 |
| 1053898403 | Heather Spallino Duplechain | Nurse Practitioner | 6713 Nelson Rd., Lake Charles, LA 70605 | 2018-07-27 |
| 1578057956 | Noor Deeb Weckerly | Nurse Practitioner | 6713 Nelson Rd, Lake Charles, LA 70605 | 2018-06-19 |
| 1861993354 | Therapy Works of Swla LLC | Physical Therapist | 4750 Lake Street, Lake Charles, LA 70605 | 2018-02-21 |
| 1669998852 | Amd Healthcare Lc, LLC | General Acute Care Hospital | 3730 Nelson Road, Lake Charles, LA 70605 | 2017-08-18 |
| 1619422474 | Kaitlyn Pinkerton | Specialist/Technologist | 800 E Mcneese St, Lake Charles, LA 70605 | 2016-08-22 |
| 1104274679 | Kelly Rogers | Counselor | 90 N. Luke 102l, Lafayette, LA 70605 | 2016-05-25 |
| 1548616220 | Lisa Monticello Snider | Neurological Surgery | 3297 Portrush Drive, Lake Charles, LA 70605 | 2016-05-11 |
| 1114387404 | Louisiana Dental Professionals, Donovan Dronet, Dds, A Professional De | Dentist | 4459 Nelson Rd, Suite 120, Lake Charles, LA 70605 | 2016-02-29 |
| Find all providers in zip 70605 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235321043 | Everett Anton Schneider | Pediatrics | 4114 Pleasant Dr, Lake Charles, LA 70605-4460 | 2007-08-15 |
| 1740346709 | Rachel Z Chatters | Pediatrics | 1935 Southwood Drive, Lake Charles, LA 70605 | 2006-12-27 |
| 1568446821 | Bertrand Joseph Foch | Pediatrics | 707a E Prien Lake Rd, Lake Charles, LA 70601-8613 | 2005-12-01 |
| 1821089673 | Susan E Drez | Pediatrics | 1000 Walters Street, Lake Charles, LA 70607 | 2005-11-01 |
| 1083605133 | Anatole Karpovs | Pediatrics | 2903 1st Ave, Lake Charles, LA 70601-8809 | 2005-10-28 |
| 1932543915 | Kenneth W. Leger | Pediatrics | 4345 Nelson Rd, Lake Charles, LA 70605-4156 | 2013-04-22 |
| 1619310992 | Stephanie Mead Treme | Pediatrics | 2903 1st Ave, Lake Charles, LA 70601-8809 | 2013-04-17 |
| 1437310703 | Caroline Champagne Courville | Pediatrics | 1525 Oak Park Blvd, Lake Charles, LA 70601-8849 | 2008-06-19 |
| 1306027701 | Kipp Burnette Ardoin | Pediatrics | 2903 1st Ave, Lake Charles, LA 70601-8809 | 2007-11-14 |
| 1699973222 | Elizabeth S Murray | Pediatrics | 1525 Oak Park Blvd, Lake Charles, LA 70601 | 2007-07-05 |
| Find all providers in LAKE CHARLES | ||||
| City | LAKE CHARLES |
| Zip Code | 70605 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.