NPIMap

Organization Active NPI

Island Medical SP LLC

  • Emergency Medicine Physician
  • Monroe, LA
National Provider Identifier
1295080869
Registry record updated Jun 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
ISLAND MEDICAL SP LLC
Practice address
309 Jackson St
Monroe, LA 71201-7407
Phone
(406) 862-3002
NPI assigned
Jul 19, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2020

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

Authorized official

Name
Ms. Amy Charley, ESQ
Title
Chief Legal Officer
Phone
(240) 686-2300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

309 Jackson St
Monroe, LA 71201-7407

Mailing address

12420 Milestone Center Dr Ste 200
Germantown, MD 20876-7111
Phone (240) 686-2300

Other names 1

  • Island Medical SP, LLC-Monroe Other name

National Provider Directory

National Provider Directory

Locations

309 Jackson St
#C
Monroe, LA 71201
Phone (318) 966-4171

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1342656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591142400000",
    "number": "1295080869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12420 MILESTONE CENTER DR STE 200",
            "city": "GERMANTOWN",
            "state": "MD",
            "postal_code": "208767111",
            "telephone_number": "240-686-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 JACKSON ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712017407",
            "telephone_number": "406-862-3002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND MEDICAL SP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-19",
        "last_updated": "2020-06-03",
        "certification_date": "2020-06-03",
        "status": "A",
        "authorized_official_last_name": "CHARLEY",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CHIEF LEGAL OFFICER",
        "authorized_official_telephone_number": "240-686-2300",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "ESQ"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Island Medical SP, LLC-Monroe",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Monroe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.