NPIMap

Organization Active NPI

Metabolic Health Restoration

  • Specialist
  • Shreveport, LA
National Provider Identifier
1144638149
Registry record updated Jul 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
C12615 Issued in LA
Legal business name
METABOLIC HEALTH RESTORATION
Practice address
8575 Fern Ave
Suite 110
Shreveport, LA 71105-5676
Phone
(318) 698-8889
Fax
(318) 698-8893
NPI assigned
Jul 23, 2014
Last updated
Jul 23, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2014

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

Authorized official

Name
Deborah K Adcock, MDNPI 1720013261
Title
Medical Director
Phone
(318) 698-8889

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X C12615 LA Primary

Addresses

Primary practice location

8575 Fern Ave
Suite 110
Shreveport, LA 71105-5676

Mailing address

8575 Fern Ave
Suite 110
Shreveport, LA 71105-5676
Phone (318) 698-8889

Other names 1

  • Diabetic Life Pulse of Louisiana, LLC Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1406073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406073600000",
    "number": "1144638149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8575 FERN AVE",
            "address_2": "SUITE 110",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055676",
            "telephone_number": "318-698-8889",
            "fax_number": "318-698-8893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8575 FERN AVE",
            "address_2": "SUITE 110",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055676",
            "telephone_number": "318-698-8889",
            "fax_number": "318-698-8893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METABOLIC HEALTH RESTORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-23",
        "last_updated": "2014-07-23",
        "status": "A",
        "authorized_official_last_name": "ADCOCK",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "318-698-8889",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "LA",
            "license": "C12615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diabetic Life Pulse of Louisiana, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Jul 23, 2014; 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.