BRENTWOOD ACQUISITION SHREVEPORT, INC (NPI# 1063644383) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1063644383 |
Entity Type | Organization |
Organization Name | BRENTWOOD ACQUISITION SHREVEPORT, INC |
Other Organization Name | BRENTWOOD OUTPATIENT CLINIC |
Practice Address |
1002 Highland Ave Suite 200 Shreveport LA 71101-4143 |
Practice Telephone | 3182226226 |
Practice Fax Number | 3182226227 |
Mailing Telephone | 3182226226 |
Mailing Fax Number | 3182226227 |
Enumeration Date | 2009-08-20 |
Last Update Date | 2009-08-20 |
Authorized Official Name | MRS. JODI LYNN BURNS (OFFICE MANAGER) |
Authorized Official Telephone | 3182226260 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
Ambulatory Health Care Facilities |
Other Name | Type Code |
---|---|
Brentwood Outpatient Clinic | Doing Business As Name - Organization |
Street Address |
1002 HIGHLAND AVE SUITE 200 |
City | SHREVEPORT |
State | LA |
Zip Code | 71101-4143 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1356319453 | Larrie Ann Williamson | Specialist | 1002 Highland Ave, Suite 201, Shreveport, LA 71101-4143 | 2006-03-14 |
1841792249 | James G Jones IIi | Nurse Practitioner | 1002 Highland Ave, Shreveport, LA 71101-4143 | 2018-03-02 |
1487009833 | Lauren A Lusk Md LLC | Psychiatry & Neurology | 1002 Highland Ave, Suite 300, Shreveport, LA 71101-4143 | 2016-05-03 |
1609202332 | John H Wagner,iii,md,llc | Psychiatry & Neurology | 1002 Highland Ave, Ste 300, Shreveport, LA 71101-4143 | 2013-09-26 |
1205135308 | Laura C Mcferrin, Bcsw, Lcsw | Social Worker | 1002 Highland Ave, Suite 200, Shreveport, LA 71101-4143 | 2011-03-15 |
1730487844 | M Patrick Davenport Appc | Psychologist | 1002 Highland Ave, 3rd Floor, Shreveport, LA 71101-4143 | 2011-03-14 |
1700188810 | Lee Stevens Md A Professional Medical Corporation | Psychiatry & Neurology | 1002 Highland Ave, Ste 300, Shreveport, LA 71101-4143 | 2010-11-22 |
1386881589 | Wendy Genora Bowlin | Counselor | 1002 Highland Ave, Ste. 101, Shreveport, LA 71101-4143 | 2009-01-10 |
1942498506 | A. Paul Willcox | Social Worker | 1002 Highland Ave, Suite 200, Shreveport, LA 71101-4143 | 2007-10-09 |
1871793935 | Mona Muriel Qualls | Counselor | 1002 Highland Ave, Suite 300, Shreveport, LA 71101-4143 | 2007-07-18 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1255988630 | Renee Jewitt | Case Manager/Care Coordinator | 1513 Line Avenue, Suite 225, Shreveport, LA 71101 | 2019-08-21 |
1942770094 | Bessie Larry | Case Manager/Care Coordinator | 1513 Line Av, 222, Shreveport, LA 71101 | 2018-12-03 |
1750875944 | Jarvis Decarleonne Larry | Community Health Worker | 1513 Line Ave # 222, Shreveport, LA 71101 | 2018-06-20 |
1871083485 | Kimberly B. Mcclelland, Lcsw | Counselor | 820 Jordan St. Ste 510w, Shreveport, LA 71101 | 2018-05-18 |
1982106456 | Hudson Amc LLC | Internal Medicine | 1800 Irving Place, Shreveport, LA 71101 | 2018-03-01 |
1528572955 | Spencer Ron Floyd | Counselor | 1717 Marshall Street, Shreveport, LA 71101 | 2017-11-21 |
1578088076 | Brittany Morris | Case Manager/Care Coordinator | 1835 Spring Street Annex Building, Shreveport, LA 71101 | 2017-08-07 |
1275058794 | Diane Williams | Case Manager/Care Coordinator | 217 Jones St Apt 510, Shreveport, LA 71101 | 2017-08-04 |
1386195972 | Jakeya Woodbury | Counselor | 453 Stoner Ave, Shreveport, LA 71101 | 2016-10-18 |
1922459643 | Arlene Huling | Counselor | 449 Egan Street, Shreveport, LA 71101 | 2016-06-23 |
Find all providers in zip 71101 |
Taxonomy Code | 261QM2500X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Medical Specialty |
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1205022647 | Jct Medical Consulting | Clinic/Center | 460 Ashley Ridge Blvd Ste 500, Shreveport, LA 71106-7228 | 2007-09-19 |
1235625252 | Discrete Enterprises | Clinic/Center | 5100 Pine Hill Rd, Shreveport, LA 71107 | 2018-07-02 |
1225211089 | Marco A. Ramos, M.d. Apc | Clinic/Center | 2800 Hearne Ave, Shreveport, LA 71103-3934 | 2007-12-14 |
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---|---|---|---|---|
1679193593 | L & F Ross Transportation, LLC | Clinic/Center | 2645 Taffy Dr, Marrero, LA 70072-5745 | 2020-04-21 |
1649709452 | Guste Plastic and Reconstructive Surgery, LLC | Clinic/Center | 3900 Veterans Blvd., Suite 200, Metairie, LA 70002 | 2017-06-06 |
1508227604 | Acadiana Allergy, Asthma and Immunology Center, LLC | Clinic/Center | 300 Rue Beauregard Ste F, Lafayette, LA 70508 | 2016-03-16 |
1215398631 | Stonewall Eye Care | Clinic/Center | 2434 Highway 171, Stonewall, LA 71078-9420 | 2016-03-11 |
1306273511 | Va Culotta Jr Md LLC | Clinic/Center | 4420 Conlin St., Ste 300, Metairie, LA 70006 | 2013-10-02 |
1306109350 | Active Spine Care LLC | Clinic/Center | 8108 Picardy Ave Ste E, Baton Rouge, LA 70809-3514 | 2012-06-22 |
1003183047 | Clear Imaging LLC | Clinic/Center | 1241a 7th St, Slidell, LA 70458-2041 | 2011-11-18 |
1295064004 | Cynthia A. Williams, A.p.m.c. | Clinic/Center | 3555 Loyola Dr, Kenner, LA 70065-7706 | 2009-12-08 |
1205075256 | Peter Hertzak M.d. Pmc | Clinic/Center | 985 Robert Blvd Ste 102, Slidell, LA 70458-2063 | 2009-02-16 |
1215191903 | Myriam D Hutchinson Md | Clinic/Center | 104 N. Hospital Dr., Abbeville, LA 70510-4039 | 2008-07-11 |
Find all providers with the same taxonomy |
City | SHREVEPORT |
Zip Code | 71101 |
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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.