NPIMap

Organization Active NPI

Brentwood Acquisition Shreveport, Inc

Doing business as Brentwood Outpatient Clinic

  • Medical Specialty Clinic/Center
  • Shreveport, LA
National Provider Identifier
1063644383
Registry record updated Aug 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
BRENTWOOD ACQUISITION SHREVEPORT, INC
Doing business as
Brentwood Outpatient Clinic
Practice address
1002 Highland Ave
Suite 200
Shreveport, LA 71101-4143
Phone
(318) 222-6226
Fax
(318) 222-6227
NPI assigned
Aug 20, 2009
Last updated
Aug 20, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2009

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

Authorized official

Name
Mrs. Jodi Lynn Burns
Title
Office Manager
Phone
(318) 222-6260

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X NU Primary

Addresses

Primary practice location

1002 Highland Ave
Suite 200
Shreveport, LA 71101-4143

Mailing address

1002 Highland Ave
Suite 200
Shreveport, LA 71101-4143
Phone (318) 222-6226

Other names 1

  • Brentwood Outpatient Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Brentwood Acq-Shreveport5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

1002 Highland Ave
Ste 200
Shreveport, LA 71101
Phone (318) 222-6226

NPI Registry JSON

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

{
    "created_epoch": "1250726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250726400000",
    "number": "1063644383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 HIGHLAND AVE",
            "address_2": "SUITE 200",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014143",
            "telephone_number": "318-222-6226",
            "fax_number": "318-222-6227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 HIGHLAND AVE",
            "address_2": "SUITE 200",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014143",
            "telephone_number": "318-222-6226",
            "fax_number": "318-222-6227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENTWOOD ACQUISITION SHREVEPORT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-20",
        "last_updated": "2009-08-20",
        "status": "A",
        "authorized_official_last_name": "BURNS",
        "authorized_official_first_name": "JODI",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "318-222-6260",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brentwood Outpatient Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 20, 2009; 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.