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Orthopaedic Clinic of Monroe

Organization Active NPI Sports Medicine (Orthopaedic Surgery) Physician · West Monroe, LA

NPI 1003337478 · NPPES record last updated Jun 16, 2018

Key facts

NPI
1003337478
Entity type
Organization (NPI type 2)
Primary specialty
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X
Legal business name
ORTHOPAEDIC CLINIC OF MONROE
Practice address
309 McMillan Rd
West Monroe, LA 71291-5323
Phone
(318) 362-4396
Fax
(318) 361-2613
NPI assigned
Jul 6, 2017
Organization subpart
No

Authorized official

Name
Kevin Goldman, CFO
Title
Administrator
Phone
(318) 362-4328

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 61

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 61

Medicare participation

Medicare fee-for-service enrollment
Enrolled in LA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20170712004069 LA DME Supplier - Physician - Orthopedic/Orthopedic Surgery 0840252698 Practice locations: West Monroe, LA

National Provider Directory

Tax ID family
The Orthoaedic CL of Mo (3 organizations share this tax ID)

Locations

312 Grammont St
Ste 200
Monroe, LA 71201
Phone (318) 362-4316

1271 Lamy Ln
Ste L
Monroe, LA 71201
Phone (318) 340-9660

1500 Commerce St
Ruston, LA 71270
Phone (318) 957-5044

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207XX0005X Yes

Addresses

Primary practice location

309 McMillan Rd
West Monroe, LA 71291-5323

Mailing address

1501 Louisville Ave
Monroe, LA 71201-6025
Phone (318) 323-8451

Other practice location 1

707 S Vienna St
Ruston, LA 71270-5845
Phone (318) 251-8001

Other identifiers

IdentifierTypeStateIssuer
1004448MedicaidLA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 16, 2018.

{
    "created_epoch": "1499299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1003337478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 LOUISVILLE AVE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712016025",
            "telephone_number": "318-323-8451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 MCMILLAN RD",
            "city": "WEST MONROE",
            "state": "LA",
            "postal_code": "712915323",
            "telephone_number": "318-362-4396",
            "fax_number": "318-361-2613"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "707 S Vienna St",
            "address_purpose": "LOCATION",
            "city": "Ruston",
            "state": "LA",
            "postal_code": "712705845",
            "country_code": "US",
            "telephone_number": "318-251-8001",
            "fax_number": "318-361-2613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ORTHOPAEDIC CLINIC OF MONROE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-06",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "GOLDMAN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-362-4328",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1004448",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Monroe, LA

All providers in West Monroe, LA · Sports Medicine (Orthopaedic Surgery) Physician in Louisiana

Sources for this page

Verify at the official NPI Registry.