DRG MEDICAL LLC (NPI# 1316418288) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316418288 |
| Entity Type | Organization |
| Organization Name | DRG MEDICAL LLC |
| Other Organization Name | GIBSON FAMILY PRACTICE |
| Practice Address |
1549 Elizabeth Ave Shreveport LA 71101-4501 |
| Practice Telephone | 3189180058 |
| Mailing Telephone | 3189180058 |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2020-10-26 |
| Authorized Official Name | DR. WILLIAM LEE GIBSON JR. (MANAGER) |
| Authorized Official Telephone | 3189180058 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities | ||
| Y | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1509639 | 05 |
| Other Name | Type Code |
|---|---|
| Gibson Family Practice | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6319 W 70th St, Shreveport, LA 711292417 | 3189180058 |
| Street Address |
1549 ELIZABETH AVE |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71101-4501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356334064 | Raymond Peter Cush | Internal Medicine | 1549 Elizabeth Ave, Shreveport, LA 71101-4501 | 2005-08-27 |
| 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 | 207QA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Addiction Medicine |
| A family medicine physician who specializes in the diagnosis and treatment of addictions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467927723 | Eugene and Oleander LLC | Family Medicine | 11715 Bricksome Ave Ste A6, Baton Rouge, LA 70816-2307 | 2018-10-12 |
| 1700305679 | Horizon Medical Treatment Centers | Family Medicine | 4313 Bluebonnet Blvd Ste B, Baton Rouge, LA 70809-9679 | 2017-09-12 |
| 1609002799 | Michael Philip Melcher | Family Medicine | 2116 N Bolton Ave, Alexandria, LA 71303-4405 | 2009-06-03 |
| 1952556094 | Chad W Trosclair | Family Medicine | 19411 Helenbirg Rd Ste 101, Covington, LA 70433-5199 | 2008-11-17 |
| 1750573747 | Louis Cataldie | Family Medicine | 6038 Jefferson Hwy, Baton Rouge, LA 70806-8013 | 2007-08-14 |
| 1154787554 | Ecl Group, LLC | Family Medicine | 2445 E Milton Ave, Youngsville, LA 70592-5346 | 2016-01-14 |
| 1265749519 | Clyde E. Elliott, M. D. A Professional Corporation | Family Medicine | 304 Circle Dr, West Monroe, LA 71291-5308 | 2010-09-08 |
| 1073732541 | Douglas Wayne Cook | Family Medicine | 86 Palmetto Rd, Rayville, LA 71269-6415 | 2007-04-24 |
| 1821004078 | Georgette Somjen | Family Medicine | 4836 Wabash St, Suite 202, Metairie, LA 70001-6717 | 2006-07-31 |
| 1356363428 | John Cedric Dauphin | Family Medicine | 809 Martin Luther King Jr Dr, Lafayette, LA 70501-1884 | 2006-07-24 |
| 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.