NPIMap

Organization Active NPI

Alfred W. Hathorn Jr., M.D. Apmc

  • Pediatrics Physician
  • Shreveport, LA
National Provider Identifier
1487066296
Registry record updated May 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
011400 Issued in LA
Legal business name
ALFRED W. HATHORN JR., M.D. APMC
Practice address
2120 Bert Koun Loop
Suite # L
Shreveport, LA 71118-3351
Phone
(318) 686-8197
Fax
(318) 688-5962
NPI assigned
May 28, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2014

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

Authorized official

Name
Ruth A Hathorn
Title
Office Manager
Phone
(318) 686-8197

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 011400 LA Primary
Acute Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2100X AP06110 LA

Addresses

Primary practice location

2120 Bert Koun Loop
Suite # L
Shreveport, LA 71118-3351

Mailing address

2120 Bert Koun Loop
Suite # L
Shreveport, LA 71118-3351
Phone (318) 686-8197

Other identifiers 2

IdentifierTypeStateIssuer
1135127MedicaidLA
2315889MedicaidLA

National Provider Directory

National Provider Directory

Locations

2120 Bert Kouns Industrial Loop
Ste L
Shreveport, LA 71118
Phone (318) 686-8197

Practitioners & affiliated clinicians

Practitioners 1

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": "1401235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401235200000",
    "number": "1487066296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2120 BERT KOUN LOOP",
            "address_2": "SUITE # L",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183351",
            "telephone_number": "318-686-8197",
            "fax_number": "318-688-5962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 BERT KOUN LOOP",
            "address_2": "SUITE # L",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183351",
            "telephone_number": "318-686-8197",
            "fax_number": "318-688-5962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALFRED W. HATHORN JR., M.D. APMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-28",
        "last_updated": "2014-05-28",
        "status": "A",
        "authorized_official_last_name": "HATHORN",
        "authorized_official_first_name": "RUTH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "318-686-8197"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "011400",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "LA",
            "license": "AP06110",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1135127",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2315889",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2014; 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.