SKINPATH DIAGNOSTICS LLC (NPI# 1306117460) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306117460 |
| Entity Type | Organization |
| Organization Name | SKINPATH DIAGNOSTICS LLC |
| Practice Address |
3000 Knight Street Bldg 5 Suite 220 Shreveport LA 71105 |
| Practice Telephone | 3188419526 |
| Practice Fax Number | 3188419551 |
| Mailing Telephone | 3188419526 |
| Mailing Fax Number | 3188419551 |
| Enumeration Date | 2012-01-21 |
| Last Update Date | 2018-04-19 |
| Authorized Official Name | DR. RYAN J MATHERNE (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 9854465888 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 293D00000X | Physiological Laboratory | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1500615 | 05 |
| Street Address |
3000 KNIGHT STREET BLDG 5 SUITE 220 |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71105 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699245928 | Misty Johnetta Ross | Counselor | 2942 Knight St., Bldg. 4 Suite 426, Shreveport, LA 71105 | 2018-11-29 |
| 1205301868 | Tatjhana Maury | Case Manager/Care Coordinator | 3325 Youree Drive, Shreveport, LA 71105 | 2018-10-10 |
| 1245710920 | Jefferey Douglas Adair Md | Non-Pharmacy Dispensing Site | 8860 Fern Ave., Suite 120, Shreveport, LA 71105 | 2018-08-21 |
| 1679059539 | Michael E Woolbert Dds LLC | Dentist | 7600 Fern Avenue, Building 1100, Shreveport, LA 71105 | 2018-07-13 |
| 1881195675 | Adiba Bibi | Pharmacist | 3555 Greenwood Road, Walgreens, Shreveport, LA 71105 | 2018-02-27 |
| 1740796655 | Allison Borel | Counselor | 2020 E 70th St Ste 201, Shreveport, LA 71105 | 2017-12-15 |
| 1073028148 | Valerie Wooten Barcelona | Physical Therapist | 130 Kayla Street, Shreveport, LA 71105 | 2017-12-11 |
| 1710497615 | Jimmy Carroll | Counselor | 2960 Knight St, Suite 110, Shreveport, LA 71105 | 2017-10-05 |
| 1932618444 | David Louis Bennett | Counselor | 3007 Knight St., Suite 200, Shreveport, LA 71105 | 2017-09-27 |
| 1619496452 | Shaqwana Hodge | Counselor | 2920 Knight St. Suite 110, Shreveport, LA 71105 | 2017-09-13 |
| Find all providers in zip 71105 | ||||
| Taxonomy Code | 293D00000X |
| Grouping | Laboratories |
| Classification | Physiological Laboratory |
| A laboratory that operates independently of a hospital and physician’s office to furnish physiological diagnostic services (e.g. EEG’s , EKG’s, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services. |
| Notes: Source: Paraphrased from the Medicare Carrier Manual, Section 2070.5. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245557701 | Global Neuro-diagnostics, Lp | Physiological Laboratory | 3939 Lakeshore Dr, Suite 4, Shreveport, LA 71109-1925 | 2010-04-23 |
| 1073926762 | Biomedical Research Foundation of Northwest Louisiana | Physiological Laboratory | 1505 Kings Hwy, Ground Floor - Pet Imaging Center, Shreveport, LA 71103-4228 | 2014-06-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780057984 | Neuralogix Management, LLC | Physiological Laboratory | 2612 Severn Ave, Suite B, Metairie, LA 70002-5935 | 2015-11-10 |
| 1235470006 | Sleep Scores, LLC | Physiological Laboratory | 19263 Chardonnay Ave, Baton Rouge, LA 70817-7670 | 2013-03-04 |
| 1720334006 | Performance Screening | Physiological Laboratory | 2438 Albany St, Ste A, Kenner, LA 70062-5244 | 2012-07-24 |
| 1710277793 | Home Testing Management | Physiological Laboratory | 155 W Hickory St, Ponchatoula, LA 70454-3215 | 2011-04-12 |
| 1952626509 | Vital Health Screenings, LLC | Physiological Laboratory | 18448 Wildlife Way Dr, Baton Rouge, LA 70817-3992 | 2010-04-06 |
| 1295911527 | Mag LLC | Physiological Laboratory | 11737 Wentling Avenue, Suite A, Baton Rouge, LA 70816-6053 | 2008-01-16 |
| 1902959752 | Sleepworks, Inc | Physiological Laboratory | 5150 Highway 22 Ste C15, Mandeville, LA 70471-2674 | 2007-01-18 |
| 1679683403 | Vascular Associates Laboratory | Physiological Laboratory | 8595 Picardy Avenue, Suite 320, Baton Rouge, LA 70809-3675 | 2006-08-30 |
| 1376650820 | Fairway Imaging, LLC | Physiological Laboratory | 1200 Pinnacle Parkway, Suite 5, Covington, LA 70433-9169 | 2006-08-23 |
| 1366498792 | Opelousas Cta, LLC | Physiological Laboratory | 1233 Wayne Gilmore Circle, 5th Floor, Opelousas, LA 70570-6404 | 2006-05-26 |
| Find all providers with the same taxonomy | ||||
| City | SHREVEPORT |
| Zip Code | 71105 |
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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.