INTEGRA HEALTH SERVICES PROFESSIONAL CORPORATION (NPI# 1861915415) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861915415 |
| Entity Type | Organization |
| Organization Name | INTEGRA HEALTH SERVICES PROFESSIONAL CORPORATION |
| Practice Address |
1110 Ringgold Ave Ste B Coushatta LA 71019-9004 |
| Mailing Address |
Po Box 53032 Shreveport LA 71135-3032 |
| Practice Telephone | 3187984606 |
| Practice Fax Number | 3187984601 |
| Mailing Telephone | 3187984606 |
| Mailing Fax Number | 3187984601 |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2018-03-17 |
| Authorized Official Name | DR. GAVIN F CHICO (MD/OWNER) |
| Authorized Official Telephone | 3187806230 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 282E00000X | Long Term Care Hospital | MD.11956R | LA | Hospitals |
| N | 283X00000X | Rehabilitation Hospital | MD.11956R | LA | Hospitals |
| Y | 207R00000X | Internal Medicine | MD.11956R | LA | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1110 Ringgold Ave, Coushatta, LA 710199000 | 3187984606 | 3187984601 |
| 4900 Medical Dr, Bossier City, LA 711124521 | 3187984606 | 3187984601 |
| Street Address |
1110 RINGGOLD AVE STE B |
| City | COUSHATTA |
| State | LA |
| Zip Code | 71019-9004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255898763 | Saint Mark Hospice and Palliative Care LLC | Hospice Care, Community Based | Saint Mark Hospice and Palliative Care LLC, 298 Army Rd, Coushatta, LA 71019 | 2019-02-21 |
| 1750824900 | Ruby Braxton | Counselor | 936 E. Carroll Street, Coushatta, LA 71019 | 2016-11-21 |
| 1447621222 | Ranette Smith | Counselor | 1414 Leigh Street, Coushatta, LA 71019 | 2015-10-19 |
| 1205157237 | Red River Parish Police Jury | Ambulance | 525 Rush Street, Coushatta, LA 71019 | 2010-06-14 |
| 1255566857 | Medcore Specialty Pharmacy | Pharmacy | 1435 E. Carroll St., Suite B, Coushatta, LA 71019 | 2009-05-27 |
| 1437346186 | Specialty Rehabilitation Hospital, L.L.C. | Rehabilitation Hospital | 1110 Ringgold Avenue, Suite B, Coushatta, LA 71019 | 2007-09-26 |
| 1679785976 | Red River Council On Aging, Inc. | Adult Companion | 1825 Front Street, Coushatta, LA 71019 | 2007-05-07 |
| 1699805515 | Red River Association for Retarded Citizens Inc | Day Training, Developmentally Disabled Services | 1908 Hwy 71 S, Coushatta, LA 71019 | 2007-03-07 |
| 1629108386 | Red River Association for Retarded Citizens Inc | Day Training, Developmentally Disabled Services | 1908 Hwy 71 South, Coushatta, LA 71019 | 2007-03-06 |
| 1245366251 | The Will of God Ministries Outreach Program | Preferred Provider Organization | 1113 Caliope Street, Coushatta, LA 71019 | 2007-02-26 |
| Find all providers in zip 71019 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
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| 1477178804 | Enclave Health Plus LLC | Internal Medicine | 327 Jefferson Oaks Dr, Ruston, LA 71270-7080 | 2020-06-11 |
| 1518581305 | Ochsner Clinic LLC | Internal Medicine | 10150 Bluebonnet Blvd, Baton Rouge, LA 70810-7131 | 2020-06-08 |
| 1205459732 | Gulf Coast Medical Specialists LLC | Internal Medicine | 1620 Belle Chasse Hwy Suite 101, Gretna, LA 70056 | 2020-05-19 |
| 1417583428 | Garbutt Medical LLC | Internal Medicine | 9373 Barringer Foreman Rd Bldg 2, Baton Rouge, LA 70809-5716 | 2020-03-21 |
| 1437784907 | Affinity Health Group, LLC | Internal Medicine | 13348 Coursey Blvd, Baton Rouge, LA 70816-4970 | 2020-03-05 |
| 1538794011 | Ochsner Clinic LLC | Internal Medicine | 4150 Nelson Rd Bldg C, Lake Charles, LA 70605-4148 | 2020-03-05 |
| 1790315026 | Cody Tingle Md LLC | Internal Medicine | 535 Pierremont Rd, Shreveport, LA 71106-2207 | 2020-01-26 |
| 1376182188 | Ochsner Clinic LLC | Internal Medicine | 5950 Bullard Ave, New Orleans, LA 70128-2816 | 2019-12-26 |
| Find all providers with the same taxonomy | ||||
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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.