Diabetic Care Centers of Louisiana Inc
Organization Active NPI Internal Medicine Physician · Gilbert, LA
NPI 1174238752 · NPPES record last updated Jun 21, 2023
Key facts
- NPI
- 1174238752
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- DIABETIC CARE CENTERS OF LOUISIANA INC
- Practice address
- 7659 Gilbert St.
Suite D
Gilbert, LA 71336 - Phone
- (318) 657-1220
- Fax
- (318) 367-1376
- NPI assigned
- Jan 18, 2023
- Organization subpart
- No
Authorized official
- Name
- Michael Shane Davidson
- Title
- Owner/Manager
- Phone
- (318) 512-1176
Practitioners 7
-
Joel Glen Eldridge, D.O.
-
Ashley Wilson, FNP-C
-
Emily Morris, FNP-C
-
Ellen Stewart Murray, APRN
-
Brittany R Basco, NP
-
Leigh Ann Chafton, FNP-BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 19D2282783 | Diabetic Care Centers of Louisiana | Certificate of waiver | May 24, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230710001792 | LA | Part B Supplier - Clinic/Group Practice | 5395104202 |
Receives reassigned benefits from 6 practitioners Practice locations: Gilbert, LA |
National Provider Directory
Locations
7659 Gilbert St
Ste D
Gilbert, LA 71336
Phone (318) 657-1220
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
7659 Gilbert St.
Suite D
Gilbert, LA 71336
Mailing address
7659 Gilbert St.
Suite D
Gilbert, LA 71336-3427
Other names
- Diabetic Care Center
Other providers in Gilbert, LA
- Donald L Englerth
- Franklin Parish Hospital Service Dist 1
- Jessica Rodgers
- Village Aesthetics LLC
- Village of Gilbert Pharmacy, LLC
All providers in Gilbert, LA · Internal Medicine Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2023. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.