PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES-SOUTHEAST, LLC (NPI# 1912303330) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912303330 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES-SOUTHEAST, LLC |
| Practice Address |
3100 Samford Ave Shreveport LA 71103-4239 |
| Mailing Address |
Po Box 865109 Orlando FL 32886-5109 |
| Practice Telephone | 3182263310 |
| Practice Fax Number | 3182264294 |
| Mailing Telephone | 8446023960 |
| Mailing Fax Number | 8132818461 |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2016-02-02 |
| Authorized Official Name | MR. JOSEPH ANTHONY GOMEZ (DIRECTOR OF O&P) |
| Authorized Official Telephone | 3182264279 |
| Authorized Official Credential | BOCO |
| Is Organization Subpart | Y |
| Parent Organization Name | PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES-SOUTHEAST, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285038489 | Pediatric Orthotic and Prosthetic Services-southeast, LLC | Prosthetic/Orthotic Supplier | 6977 Main St, Houston, TX 77030-3701 | 2014-10-16 |
| Street Address |
3100 SAMFORD AVE |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71103-4239 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588634133 | Emily Hummer Naus | Anesthesiology | 3100 Samford Ave, Shreveport, LA 71103-4239 | 2006-01-25 |
| 1104311778 | Amanda Carfagno | Nurse Practitioner | 3100 Samford Ave, Shreveport, LA 71103-4239 | 2018-06-26 |
| 1922596170 | Shriners Hospitals for Children | Anesthesiology | 3100 Samford Ave, Shreveport, LA 71103-4239 | 2018-04-24 |
| 1568803732 | Shriners Hospitals for Children | Orthopaedic Surgery | 3100 Samford Ave, Shreveport, LA 71103-4239 | 2013-07-16 |
| 1962751495 | Linda Scoggins Beckermeyer | Nurse Practitioner | 3100 Samford Ave, Shreveport, LA 71103-4239 | 2012-08-30 |
| 1356641799 | Shiela Eileen Sterling | Physical Therapist | 3100 Samford Ave, Shreveport, LA 71103-4239 | 2010-11-02 |
| 1285934620 | Shannon Marie Davis | Physical Therapist | 3100 Samford Ave, Shreveport, LA 71103-4239 | 2010-11-02 |
| 1386944718 | Deborah Banks | Physical Therapist | 3100 Samford Ave, Shreveport, LA 71103-4239 | 2010-11-02 |
| 1659671097 | Natalie Wooley Bomar | Occupational Therapist | 3100 Samford Ave, Shreveport, LA 71103-4239 | 2010-11-02 |
| 1255631594 | Susan Saylors Bryant | Physical Therapist | 3100 Samford Ave, Shreveport, LA 71103-4239 | 2010-11-02 |
| Find all providers in the same location | ||||
| 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 | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295242311 | Romunda Lockett | Prosthetic/Orthotic Supplier | 902 Pierre Ave, Shreveport, LA 71103-2828 | 2018-01-10 |
| 1053623157 | Butterfly Boutique, LLC | Prosthetic/Orthotic Supplier | 1950 E 70th St, Suite G, Shreveport, LA 71105-5345 | 2010-07-06 |
| 1841427788 | Magnolia Durable Medical Equipment Inc. | Prosthetic/Orthotic Supplier | 2005 Creswell Street, Shreveport, LA 71104-2201 | 2009-06-18 |
| 1093963878 | Snells Limbs & Braces of Shreveport LLC | Prosthetic/Orthotic Supplier | 8730 Youree Dr, Building A, Shreveport, LA 71115-2518 | 2008-09-04 |
| 1316195795 | Riffle Prosthetics and Orthotics Inc | Prosthetic/Orthotic Supplier | 1938 E 70th St, Suite D, Shreveport, LA 71105-5340 | 2008-08-28 |
| 1982867032 | Arnold O & P Lab, Inc | Prosthetic/Orthotic Supplier | 619 Jordan Street, Shreveport, LA 71101 | 2008-07-09 |
| 1548447568 | Kitty A Roark. | Prosthetic/Orthotic Supplier | 855 Pierremont Rd Ste 126, Shreveport, LA 71106-2074 | 2008-01-22 |
| 1851442503 | Snells Limbs & Braces of Shreveport LLC | Prosthetic/Orthotic Supplier | 1833 Line Ave, Shreveport, LA 71101-4611 | 2007-01-16 |
| 1811961436 | Promyse-prosthetic Orthotic Group | Prosthetic/Orthotic Supplier | 3227 Portland Ave, Shreveport, LA 71103-4026 | 2006-02-13 |
| 1235139098 | Red River Orthotic Specialists, LLC | Prosthetic/Orthotic Supplier | 820 Jordan St, Suite 110, Shreveport, LA 71101-4518 | 2005-07-22 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71103 |
Please comment or provide details below to improve the information on PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES-SOUTHEAST, LLC.
| 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.