Southern Pediatric Clinic
NPI 1104297720 · Health Service Clinic/Center · Shreveport, LA
Southern Pediatric Clinic is a Health Service Clinic/Center organization in Shreveport, LA (NPI 1104297720).
Provider details
- NPI number
- 1104297720
- Entity type
- Organization
- Primary specialty
- Health Service Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Stella Immanuel, Owner(318) 221-0277
- License
- MD12866R (LA)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
10 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2015-10-08
- Last updated
- 2015-11-03
Frequently asked questions
- What is Southern Pediatric Clinic's NPI number?
- Southern Pediatric Clinic's National Provider Identifier (NPI) is 1104297720, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Southern Pediatric Clinic?
- Southern Pediatric Clinic is classified in the NPPES registry as Health Service Clinic/Center (Ambulatory Health Care Facilities).
- Where is Southern Pediatric Clinic located?
- Southern Pediatric Clinic's practice location on file with NPPES is 202 N Thomas Dr, Shreveport, LA 71107-6539.
- What is Southern Pediatric Clinic's phone number?
- The practice phone number listed in the NPPES registry for Southern Pediatric Clinic is (318) 221-0277.
- Who is the authorized official for Southern Pediatric Clinic?
- The authorized official listed on Southern Pediatric Clinic's NPPES record is Stella Immanuel, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Southern Pediatric Clinic's NPI active?
- Yes — Southern Pediatric Clinic's NPI (1104297720) is active in the NPPES registry as of the last update on 2015-11-03.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.