NPIMap

Organization Active NPI

Shreveport Family Medicine Inc

  • Adult Medicine Physician
  • Shreveport, LA
National Provider Identifier
1003975079
Registry record updated Jun 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
SHREVEPORT FAMILY MEDICINE INC
Practice address
7505 Pines Road
Suite 1250
Shreveport, LA 71129-3927
Phone
(318) 686-3770
Fax
(318) 686-3838
NPI assigned
Dec 6, 2006
Last updated
Jun 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Shelia L. Jackson
Title
Administrator
Phone
(318) 686-3770

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X NU Primary

Addresses

Primary practice location

7505 Pines Road
Suite 1250
Shreveport, LA 71129-3927

Mailing address

7505 Pines Rd
Suite 1250
Shreveport, LA 71129-3935
Phone (318) 686-3770

National Provider Directory

National Provider Directory

Locations

6821 Pines Rd
Ste 100
Shreveport, LA 71129
Phone (318) 686-3770

7505 Pines Rd
Ste 1250
Shreveport, LA 71129
Phone (318) 686-3770

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1003975079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7505 PINES RD",
            "address_2": "SUITE 1250",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711293935",
            "telephone_number": "318-686-3770",
            "fax_number": "318-686-3838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7505 PINES ROAD",
            "address_2": "SUITE 1250",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711293927",
            "telephone_number": "318-686-3770",
            "fax_number": "318-686-3838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHREVEPORT FAMILY MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "SHELIA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-686-3770",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.