NPIMap

Organization Active NPI

Northshore Incs, LLC

  • Point of Service
  • Slidell, LA
National Provider Identifier
1396868550
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Point of ServiceTaxonomy code 305S00000X
License
10387 Issued in LA
Legal business name
NORTHSHORE INCS, LLC
Practice address
742 E I 10 Service Rd
Slidell, LA 70461-5518
Phone
(985) 649-1605
NPI assigned
Apr 10, 2007
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
Mr. Chris Tedesco
Title
Program Coordinator
Phone
(985) 649-1605

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Point of Service 305S00000X 10387 LA Primary

Addresses

Primary practice location

742 E I 10 Service Rd
Slidell, LA 70461-5518

Mailing address

742 E I 10 Service Rd
Slidell, LA 70461-5518
Phone (985) 649-1605

Other identifiers 1

IdentifierTypeStateIssuer
1150975MedicaidLA

National Provider Directory

National Provider Directory
Tax ID family
Northshore Incs LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396868550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "742 E I 10 SERVICE RD",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704615518",
            "telephone_number": "985-649-1605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "742 E I 10 SERVICE RD",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704615518",
            "telephone_number": "985-649-1605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSHORE INCS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TEDESCO",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "PROGRAM COORDINATOR",
        "authorized_official_telephone_number": "985-649-1605",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "LA",
            "license": "10387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1150975",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Slidell, 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.