NPIMap

Organization Active NPI

Louisiana State University Health Sciences Center Viral Disease Clini

  • Clinic/Center
  • Shreveport, LA
National Provider Identifier
1285635540
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER VIRAL DISEASE CLINI
Practice address
6670 Saint Vincent Ave
Shreveport, LA 71106-2638
Phone
(318) 862-9986
NPI assigned
Aug 9, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Robert Penn, MD
Title
Medical Director
Phone
(318) 798-5930

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X LA Primary

Addresses

Primary practice location

6670 Saint Vincent Ave
Shreveport, LA 71106-2638

Mailing address

1821 Bayou Dr
Shreveport, LA 71105-3403
Phone (318) 865-2578

Other identifiers 1

IdentifierTypeStateIssuer
1697770MedicaidLA

National Provider Directory

National Provider Directory
Tax ID family
Lsu HLTH Sciences Ctr15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285635540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 BAYOU DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711053403",
            "telephone_number": "318-865-2578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6670 SAINT VINCENT AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711062638",
            "telephone_number": "318-862-9986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER VIRAL DISEASE CLINI",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PENN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "318-798-5930",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1697770",
            "state": "LA"
        }
    ],
    "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 Aug 22, 2020; 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.