Organization Active NPI

Coushatta ER Physicians

  • Emergency Medicine Physician
  • Coushatta, LA
National Provider Identifier
1427480680
Registry record updated Mar 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
COUSHATTA ER PHYSICIANS
Practice address
1635 Marvel St
Coushatta, LA 71019-9022
Phone
(318) 932-9980
Fax
(318) 932-9906
NPI assigned
Jul 30, 2013
Last updated
Mar 4, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2016

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

Authorized official

Name
Dr. Wyche Taylor Coleman Jr., MDNPI 1710984513
Title
MD/Owner
Phone
(318) 932-9980

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

1635 Marvel St
Coushatta, LA 71019-9022

Mailing address

PO Box 52311
Shreveport, LA 71135-2311
Phone (318) 798-4539

Other identifiers 2

IdentifierTypeStateIssuer
2349309MedicaidLA
DU5881OtherLARR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131226001361 LA Part B Supplier - Clinic/Group Practice 2860629631 Receives reassigned benefits from 15 practitioners
Practice locations: Coushatta, LA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1375142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457049600000",
    "number": "1427480680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 52311",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711352311",
            "telephone_number": "318-798-4539",
            "fax_number": "318-798-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1635 MARVEL ST",
            "city": "COUSHATTA",
            "state": "LA",
            "postal_code": "710199022",
            "telephone_number": "318-932-9980",
            "fax_number": "318-932-9906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUSHATTA ER PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-30",
        "last_updated": "2016-03-04",
        "status": "A",
        "authorized_official_last_name": "COLEMAN",
        "authorized_official_first_name": "WYCHE",
        "authorized_official_middle_name": "TAYLOR",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "318-932-9980",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2349309",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DU5881",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coushatta, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.