Vicki S. Cobb, MD
Individual provider Active NPI Family Medicine Physician · Benton, LA
NPI 1366470205 · NPPES record last updated Nov 21, 2007
Key facts
- NPI
- 1366470205
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 018464 (LA)
- Practice address
- 4707 Palmetto Rd
Benton, LA 71006-9712 - Phone
- (318) 965-9644
- Fax
- (318) 965-9640
- NPI assigned
- Jun 29, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Louisiana State University School of Medicine in Shreveport, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
4707 Palmetto Rd
Benton, LA 71006-9712
Phone (318) 965-9644
Hospital & facility affiliations
- Willis Knighton Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051031000793 | LA | Practitioner - Family Practice | 0547287393 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 018464 | LA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Bossier Family Medicine | Family Medicine | Current |
Accepting new patients |
Locations
4707 Palmetto Rd
Benton, LA 71006
Phone (318) 965-6944
1202 Louisiana Ave
Shreveport, LA 71101
Phone (318) 212-8946
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 018464 | LA | Yes |
Addresses
Primary practice location
4707 Palmetto Rd
Benton, LA 71006-9712
Mailing address
4707 Palmetto Rd
Benton, LA 71006-9712
Phone (318) 965-9644
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386600 | Medicaid | LA |
Other providers in Benton, LA
- Ricarter Sylvester Broomes
- Lindsey Tassin Brown
- Calvary Care Service LLC
- Can DO Kids Pediatric Therapy Services
- Anna Caughman
- Community Bridges South, Inc.
- Community Bridges West, Inc.
- Courtney Miller, LPC North Bossier Counseling Corp
- Michael David Crawford
- Brian Lee Crenshaw
All providers in Benton, LA · Family 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 Nov 21, 2007. 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.
- Order and Referring (CMS).
- 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.