JAMES S LILLICH (NPI# 1619969342) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619969342 |
| Entity Type | Individual |
| Full Name | JAMES S LILLICH |
| Credential | MD |
| Practice Address |
1500 Line Avenue Ste 100 Shreveport LA 71101 |
| Mailing Address |
1534 Elizabeth Ave Ste 301 Shreveport LA 71101-4531 |
| Practice Telephone | 3186353052 |
| Practice Fax Number | 3186326087 |
| Mailing Telephone | 3186295001 |
| Mailing Fax Number | 3186295020 |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2020-07-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207XX0004X |
Orthopaedic Surgery Specialization: Foot and Ankle Surgery |
15579 | LA | Allopathic & Osteopathic Physicians |
| Y | 207XX0004X |
Orthopaedic Surgery Specialization: Foot and Ankle Surgery |
015579 | LA | Allopathic & Osteopathic Physicians |
| Street Address |
1500 LINE AVENUE STE 100 |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295739001 | William L Overdyke | Orthopaedic Surgery | 1500 Line Avenue, Suite 100, Shreveport, LA 71101 | 2005-06-09 |
| 1790196657 | Specialists Hospital Shreveport | Pharmacy | 1500 Line Avenue, Suite 206, Shreveport, LA 71101 | 2014-05-14 |
| 1417189465 | Clay Eric Morgan | Physician Assistant | 1500 Line Avenue, Ste 100, Shreveport, LA 71101-4639 | 2009-08-10 |
| 1659503613 | Trey M Harold | Physician Assistant | 1500 Line Avenue, Suite 100, Shreveport, LA 71101-4639 | 2009-08-10 |
| 1104057694 | Specialists Hospital Shreveport, LLC | Prosthetic/Orthotic Supplier | 1500 Line Avenue, Suite 206, Shreveport, LA 71101-4639 | 2009-07-31 |
| 1598891491 | Stephen Michael Brandao Jr. | Nurse Practitioner | 1500 Line Avenue, Ste 200, Shreveport, LA 71101 | 2007-02-26 |
| 1992831895 | Joseph Michael Angelo | Physician Assistant | 1500 Line Avenue, Ste 100, Shreveport, LA 71101 | 2007-02-26 |
| 1891821583 | Chris D Howard | Nurse Practitioner | 1500 Line Avenue, Ste 200, Shreveport, LA 71101 | 2007-02-26 |
| 1255470118 | John David Googe | Orthopaedic Surgery | 1500 Line Avenue, Ste 100, Shreveport, LA 71101 | 2007-02-06 |
| 1346393816 | Michele Allison | Occupational Therapist | 1500 Line Avenue, Ste 100, Shreveport, LA 71101 | 2007-01-19 |
| Find all providers in the same location | ||||
| 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 | 207XX0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Foot and Ankle Surgery |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, foot and ankle surgeons deal with adult reconstructive foot and ankle surgery, adult foot and ankle trauma, sports medicine foot and ankle, and children's foot and ankle reconstructive surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: title modified, definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. ACGME Accredited Residency Program Requirements: 1 year of training with 5 years Orthopedic Surgery for a total of 6 years. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801976212 | John V. Marymont | Orthopaedic Surgery | 1501 Kings Hwy, Department of Orthopedics, Shreveport, LA 71103-4228 | 2006-10-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467516567 | Meredith Ann Warner | Orthopaedic Surgery | 18161 E Petroleum Dr, Baton Rouge, LA 70809-6104 | 2006-12-21 |
| 1720006687 | Paul E Fenn Jr. | Orthopaedic Surgery | 105 Patriot Ave, Suite 101, Lafayette, LA 70508 | 2006-07-18 |
| 1700817673 | Roger H Ogden II II | Orthopaedic Surgery | 2731 Napoleon Avenue, Southern Orthopaedic Specialists, New Orleans, LA 70115 | 2006-07-06 |
| 1275518110 | Grant Arthur Dona | Orthopaedic Surgery | 1501 Louisville Ave, Monroe, LA 71201-6025 | 2005-12-14 |
| 1811994759 | Christopher Hebert | Orthopaedic Surgery | 108 Rue Louis Xiv, Lafayette, LA 70508-5739 | 2005-07-07 |
| 1679818892 | Center for Innovations In Evaluative Medicine | Orthopaedic Surgery | 18161 E Petroleum Dr, Baton Rouge, LA 70809-6104 | 2012-11-28 |
| 1295025138 | Julie Ann Neumann | Orthopaedic Surgery | 7301 Hennessy Blvd Ste 200, Baton Rouge, LA 70808-4794 | 2011-04-12 |
| 1295782647 | Janet E. Lewis | Orthopaedic Surgery | 501 S Pine St, Deridder, LA 70634-4939 | 2006-05-30 |
| City | SHREVEPORT |
| Zip Code | 71101 |
Please comment or provide details below to improve the information on JAMES S LILLICH.
| 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.