NPIMap

Organization Active NPI

Northeast Louisiana Kidney Specialists,LLC

  • Nephrology Physician
  • Monroe, LA
National Provider Identifier
1568413185
Registry record updated Dec 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
NORTHEAST LOUISIANA KIDNEY SPECIALISTS,LLC
Practice address
711 Wood St
Ste a
Monroe, LA 71201-7549
Phone
(318) 323-8847
Fax
(318) 327-3410
NPI assigned
May 16, 2006
Last updated
Dec 14, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2009

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

Authorized official

Name
Misti Williams
Title
Credentialing/Billing
Phone
(318) 323-8847

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X NU Primary

Addresses

Primary practice location

711 Wood St
Ste a
Monroe, LA 71201-7549

Mailing address

711 Wood St
Ste a
Monroe, LA 71201-7549
Phone (318) 323-8847

Other identifiers 1

IdentifierTypeStateIssuer
1949132MedicaidLA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041106000139 LA Part B Supplier - Clinic/Group Practice 5799748182 Receives reassigned benefits from 9 practitioners
Practice locations: Monroe, LA

National Provider Directory

National Provider Directory

Member organizations 5

Organizations listed as members of this organization in the National Provider Directory.

Locations

615 Wood St
Monroe, LA 71201
Phone (318) 323-8847

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260748800000",
    "number": "1568413185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 WOOD ST",
            "address_2": "STE A",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712017549",
            "telephone_number": "318-323-8847",
            "fax_number": "318-327-3410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 WOOD ST",
            "address_2": "STE A",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712017549",
            "telephone_number": "318-323-8847",
            "fax_number": "318-327-3410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST LOUISIANA KIDNEY SPECIALISTS,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2009-12-14",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "MISTI",
        "authorized_official_title_or_position": "CREDENTIALING/BILLING",
        "authorized_official_telephone_number": "318-323-8847"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1949132",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2009; 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.