NPIMap

Organization Active NPI

KSR Medical LLC

  • Medical Specialty Clinic/Center
  • Leesville, LA
National Provider Identifier
1346493269
Registry record updated Oct 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
202557 Issued in LA
Legal business name
KSR MEDICAL LLC
Practice address
1015 W Fertitta Blvd
Leesville, LA 71446-4646
Phone
(337) 239-4130
Fax
(337) 238-9030
NPI assigned
Oct 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2008

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

Authorized official

Name
Dr. Khaled Mostafa Ghorab, MD
Title
Owner
Phone
(337) 239-4130

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 202557 LA Primary

Addresses

Primary practice location

1015 W Fertitta Blvd
Leesville, LA 71446-4646

Mailing address

1015 W Fertitta Blvd
Leesville, LA 71446-4646
Phone (337) 239-4130

Other identifiers 1

IdentifierTypeStateIssuer
202557OtherLALOUISIANA STATE LICENCE

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1224720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224720000000",
    "number": "1346493269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 W FERTITTA BLVD",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "714464646",
            "telephone_number": "337-239-4130",
            "fax_number": "337-238-9030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 W FERTITTA BLVD",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "714464646",
            "telephone_number": "337-239-4130",
            "fax_number": "337-238-9030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KSR MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-23",
        "last_updated": "2008-10-23",
        "status": "A",
        "authorized_official_last_name": "GHORAB",
        "authorized_official_first_name": "KHALED",
        "authorized_official_middle_name": "MOSTAFA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "337-239-4130",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "LA",
            "license": "202557",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LOUISIANA STATE LICENCE",
            "identifier": "202557",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesville, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2008; 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.