NPIMap

Organization Active NPI

Louisiana State University Health Sciences Center

  • Surgery Physician
  • Shreveport, LA
National Provider Identifier
1104860121
Registry record updated Dec 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
142 Issued in LA
Legal business name
LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
Practice address
1501 Kings Hwy
Lsuhsc-S Department of Surgery
Shreveport, LA 71103-4228
Phone
(318) 675-7737
Fax
(318) 675-5666
NPI assigned
Jun 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2007

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

Authorized official

Name
Mrs. Melanie Hardegree Sotak, MHSA
Title
Director of Managed Care
Phone
(318) 675-7737

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X 142 LA
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X 142 LA Primary

Addresses

Primary practice location

1501 Kings Hwy
Lsuhsc-S Department of Surgery
Shreveport, LA 71103-4228

Mailing address

1501 Kings Hwy
Lsuhsc-S Department of Surgery
Shreveport, LA 71103-4228
Phone (318) 675-7737

Other identifiers 1

IdentifierTypeStateIssuer
1798771MedicaidLA

Other names 1

  • LSUHSC-S Department of Surgery Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 44

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

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198713600000",
    "number": "1104860121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "address_2": "LSUHSC-S DEPARTMENT OF SURGERY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-675-7737",
            "fax_number": "318-675-5666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "address_2": "LSUHSC-S DEPARTMENT OF SURGERY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-675-7737",
            "fax_number": "318-675-5666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2007-12-27",
        "status": "A",
        "authorized_official_last_name": "SOTAK",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_middle_name": "HARDEGREE",
        "authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE",
        "authorized_official_telephone_number": "318-675-7737",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MHSA"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "LA",
            "license": "142",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "LA",
            "license": "142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1798771",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LSUHSC-S Department of Surgery",
            "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 Dec 27, 2007; 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.