SPECIALISTS HOSPITAL SHREVEPORT (NPI# 1790196657) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790196657 |
| Entity Type | Organization |
| Organization Name | SPECIALISTS HOSPITAL SHREVEPORT |
| Practice Address |
1500 Line Avenue Suite 206 Shreveport LA 71101 |
| Practice Telephone | 3182133800 |
| Mailing Telephone | 3182133800 |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2014-05-14 |
| Authorized Official Name | MRS. KANDI MOORE (CEO) |
| Authorized Official Telephone | 3182133800 |
| Authorized Official Credential | CEO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
011350 | LA | Suppliers |
| Street Address |
1500 LINE AVENUE SUITE 206 |
| 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 |
| 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 |
| 1073585477 | Philip Andrew Utter | Neurological Surgery | 1500 Line Avenue, Ste 200, Shreveport, LA 71101 | 2006-02-02 |
| 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 | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689077430 | University Health Shreveport LLC | Pharmacy | 1606 Kings Hwy Rm 2263, Shreveport, LA 71103-4128 | 2014-10-07 |
| 1104268390 | Freds Stores of Tennessee Inc | Pharmacy | 5907 Old Mooringsport Road, Shreveport, LA 71107-2023 | 2013-07-29 |
| 1619058468 | Line Avenue Pharmacy Inc | Pharmacy | 1822 Line Ave, Shreveport, LA 71101-4612 | 2006-10-18 |
| 1215031141 | Louisiana Cvs Pharmacy, L.L.C. | Pharmacy | 3300 Youree Dr, Shreveport, LA 71105-2116 | 2006-09-12 |
| 1033213962 | Louisiana Cvs Pharmacy, L.L.C. | Pharmacy | 9194 Mansfield Rd, Shreveport, LA 71118-3123 | 2006-09-12 |
| 1497760664 | Walgreen Co | Pharmacy | 3124 Line Ave, Shreveport, LA 71104-4240 | 2006-07-29 |
| 1023023298 | Walgreen Co | Pharmacy | 6101 W 70th St, Shreveport, LA 71129-2507 | 2006-07-29 |
| 1235144411 | Walgreen Co | Pharmacy | 3100 N Market St, Shreveport, LA 71107-4005 | 2006-07-29 |
| 1043225212 | Walgreen Co | Pharmacy | 300 Southfield Rd, Shreveport, LA 71105-4112 | 2006-07-29 |
| 1134134307 | Walgreen Co | Pharmacy | 3555 Greenwood Rd, Shreveport, LA 71109-5209 | 2006-07-29 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71101 |
Please comment or provide details below to improve the information on SPECIALISTS HOSPITAL SHREVEPORT.
| 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.