NPIMap

Organization Active NPI

Southern Kidney Associates PLLC

  • Nephrology Physician
  • Shreveport, LA
National Provider Identifier
1194292516
Registry record updated Oct 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
SOUTHERN KIDNEY ASSOCIATES PLLC
Practice address
1815 E 70TH St
Shreveport, LA 71105-5301
Phone
(800) 276-9017
Fax
(903) 234-9992
NPI assigned
Oct 24, 2018
Last updated
Oct 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2021

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

Authorized official

Name
Mrs. Tiffany Hagood, RN
Title
Practice Administrator
Phone
(903) 234-9992

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X NU Primary

Addresses

Primary practice location

1815 E 70TH St
Shreveport, LA 71105-5301

Mailing address

3535 N Fourth St Ste 301
Longview, TX 75605-0037
Phone (800) 276-9017

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181205002765 LA Part B Supplier - Clinic/Group Practice 8325382146 Receives reassigned benefits from 6 practitioners
Practice locations: Shreveport, LA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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": "1540339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633478400000",
    "number": "1194292516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 N FOURTH ST STE 301",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756050037",
            "telephone_number": "800-276-9017",
            "fax_number": "903-234-8287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 E 70TH ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055301",
            "telephone_number": "800-276-9017",
            "fax_number": "903-234-9992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN KIDNEY ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-24",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A",
        "authorized_official_last_name": "HAGOOD",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "903-234-9992",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "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 Oct 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.