DAVID RAINES COMMUNITY HEALTH CENTER, INC. (NPI# 1437673464) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437673464 |
| Entity Type | Organization |
| Organization Name | DAVID RAINES COMMUNITY HEALTH CENTER, INC. |
| Other Organization Name | DAVID RAINES SCHOOL BASED HEALTH CENTER-JS CLARK |
| Practice Address |
351 Hearne Ave Shreveport LA 71103-2019 |
| Mailing Address |
3041 Martin Luther King Drive Shreveport LA 71107-4705 |
| Practice Telephone | 3184258742 |
| Mailing Telephone | 3182273350 |
| Mailing Fax Number | 3182222979 |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2017-08-01 |
| Authorized Official Name | MR. WILLIE C. WHITE III (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 3182273350 |
| Authorized Official Credential | CEO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1941638 | 05 |
| Other Name | Type Code |
|---|---|
| David Raines School Based Health Center-JS Clark | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760042394 | David Raines Community Health Center, Inc. | Clinic/Center | 4331 Henry St, Shreveport, LA 71109-6820 | 2019-06-17 |
| 1487178315 | David Raines Community Health Center, Inc. | Clinic/Center | 7611 Saint Vincent Ave, Shreveport, LA 71106-4231 | 2017-08-02 |
| 1760904981 | David Raines Community Health Center, Inc. | Clinic/Center | 401 W 70th St, Shreveport, LA 71106-3034 | 2017-07-10 |
| 1104249473 | David Raines Community Health Center, Inc. | Clinic/Center | 3021 W 70th St, Shreveport, LA 71108-4603 | 2014-01-22 |
| Street Address |
351 HEARNE AVE |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71103-2019 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376092510 | Tanquenika Markray | Nurse Practitioner | 351 Hearne Ave, Shreveport, LA 71103-2019 | 2016-09-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083124887 | Elizabeth Ponder | Case Manager/Care Coordinator | 404 Hearne Avenue, Shreveport, LA 71103 | 2017-10-05 |
| 1245648393 | Madiha Tariq | General Acute Care Hospital | Rheumatology Clinic, 1501 Kings Hwy, Sheveport, LA 71103 | 2014-07-31 |
| 1659782688 | Jennifer G Smith | Pharmacist | 1725 Claiborne Ave, Shreveport, LA 71103 | 2014-05-13 |
| 1336568823 | Taylor Jieun Jung | Student in an Organized Health Care Education/Training Program | Lsu Health Sciences Center 1501 Kings Highway, Department of Oral & Maxillofacial Surgery Room 530, Shreveport, LA 71103 | 2014-04-10 |
| 1578984746 | Jamie Terrell | Pharmacist | 1625 Claiborne Ave, Shreveport, LA 71103 | 2013-12-13 |
| 1346675188 | Srijan Tandukar | Internal Medicine | 2751 Albert L Bicknell Dr Ste 2b, Shreveport, LA 71103 | 2013-09-12 |
| 1699017681 | Deanna Elise Mossallati | Internal Medicine | 8551 Greenwood Rd, Suite 410, Shreveport, LA 71103 | 2013-03-18 |
| 1346527330 | Tim M Smith | Clinical Exercise Physiologist | 3200 Greenwood Rd., Shreveport, LA 71103 | 2011-11-04 |
| 1144451683 | Second Chance Recovery | Durable Medical Equipment & Medical Supplies | 3816 Linwood, Shreveport, LA 71103 | 2009-07-31 |
| 1093919920 | Neeraj Singh | Internal Medicine | 2751 Albert L Bicknell Dr Fl 4, Shreveport, LA 71103 | 2007-06-13 |
| Find all providers in zip 71103 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467061515 | Council for Advancement of Social Service and Education | Clinic/Center | 1560 Irving Place, Shreveport, LA 71101-4604 | 2020-07-24 |
| 1306455456 | Council for Advancement of Social Service and Education | Clinic/Center | 2120 Bert Kouns Industrial Loop Ste K-l, Shreveport, LA 71118-3351 | 2020-07-24 |
| 1760042394 | David Raines Community Health Center, Inc. | Clinic/Center | 4331 Henry St, Shreveport, LA 71109-6820 | 2019-06-17 |
| 1215933254 | David Raines Community Health Center, Inc | Clinic/Center | 3041 Dr Martin Luther King Dr, Shreveport, LA 71107-4705 | 2005-06-23 |
| 1144705930 | David Raines Community Health Center Inc | Clinic/Center | 1625 David Raines Rd, Shreveport, LA 71107-5899 | 2018-09-27 |
| 1487178315 | David Raines Community Health Center, Inc. | Clinic/Center | 7611 Saint Vincent Ave, Shreveport, LA 71106-4231 | 2017-08-02 |
| 1760906630 | David Raines Community Health Center | Clinic/Center | 7340 Wyngate Blvd, Shreveport, LA 71106-3920 | 2017-08-01 |
| 1760904981 | David Raines Community Health Center, Inc. | Clinic/Center | 401 W 70th St, Shreveport, LA 71106-3034 | 2017-07-10 |
| 1134532062 | Council for Advancement of Social Service and Education | Clinic/Center | 2120 Bert Kouns Industrial Loop, Suite A, Shreveport, LA 71118-3351 | 2014-06-09 |
| 1104249473 | David Raines Community Health Center, Inc. | Clinic/Center | 3021 W 70th St, Shreveport, LA 71108-4603 | 2014-01-22 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71103 |
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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.