NPIMap

Organization Active NPI

Louisiana State University Health Sciences Center

  • Nephrology Physician
  • Shreveport, LA
National Provider Identifier
1649438532
Registry record updated May 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
142 Issued in LA
Legal business name
LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
Practice address
1501 Kings Hwy
Department of Internal Medicine - Section of Nephrology
Shreveport, LA 71103-4228
Phone
(318) 424-4008
Fax
(318) 424-6606
NPI assigned
May 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2008

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

Authorized official

Name
Mrs. Melanie Sotak, MHSA
Title
Director of Managed Care
Phone
(318) 675-7737

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X 142 LA Primary

Addresses

Primary practice location

1501 Kings Hwy
Department of Internal Medicine - Section of Nephrology
Shreveport, LA 71103-4228

Mailing address

1501 Kings Hwy
Department of Internal Medicine - Nephrology Section
Shreveport, LA 71103-4228
Phone (318) 675-7402

Other identifiers 1

IdentifierTypeStateIssuer
1444715MedicaidLA

Other names 1

  • LSUHSC Nephrology Group Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1211932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211932800000",
    "number": "1649438532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "address_2": "DEPARTMENT OF INTERNAL MEDICINE - NEPHROLOGY SECTION",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-675-7402",
            "fax_number": "318-675-5913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "address_2": "DEPARTMENT OF INTERNAL MEDICINE - SECTION OF NEPHROLOGY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-424-4008",
            "fax_number": "318-424-6606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-28",
        "last_updated": "2008-05-28",
        "status": "A",
        "authorized_official_last_name": "SOTAK",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE",
        "authorized_official_telephone_number": "318-675-7737",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MHSA"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "LA",
            "license": "142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1444715",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LSUHSC Nephrology Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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, 2008; 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.