Christopher Troy Bamburg, PA-C
Individual provider Active NPI Medical Physician Assistant · Coushatta, LA
NPI 1003365636 · NPPES record last updated Jul 3, 2019
Key facts
- NPI
- 1003365636
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 303579 (LA)
- Practice address
- 1635 Marvel St
Coushatta, LA 71019-9022 - Phone
- (318) 932-2000
- NPI assigned
- Sep 23, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161117001767 | LA | Practitioner - Physician Assistant | 6305125139 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Christus Health Central Louisiana | Current |
Accepting new patients | |
| Christus Health Central Louisiana | Current |
Accepting new patients |
Locations
1635 Marvel St
Coushatta, LA 71019
Phone (318) 932-2000
Interoperability endpoints
- cbamburg418639@christushealth.direct-ci.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 303579 | LA | |
| Medical Physician Assistant | 363AM0700X | 303579 | LA | Yes |
Addresses
Primary practice location
1635 Marvel St
Coushatta, LA 71019-9022
Mailing address
200 Corporate Blvd
Lafayette, LA 70508-3870
Phone (800) 893-9698
Other practice location 1
2510 Bert Kouns Industrial Loop
Shreveport, LA 71118-3180
Phone (318) 212-5000
Other providers in Coushatta, LA
- Advantage Home Health Care, Inc.
- Advantage Home Health Care, Inc.
- Alayna Faith Austin
- Lavora Babers-Wilson
- Bridgette Neal Bates
- Kelley Kaitlyn Squires Beard
- Don Gregory Bell
- Shannon Gammill Berry
- Bio-Medical Applications of Louisiana, LLC
All providers in Coushatta, LA · Medical Physician Assistant in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.