Independence Medical Clinic, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

INDEPENDENCE MEDICAL CLINIC, LLC

Practice address

281 W 4TH St
Independence, LA 70443-2386

Phone

(504) 338-4268

NPI assigned

Feb 27, 2014

Last updated

Jul 10, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Edmond Wood, MD

Title

Owner

Phone

(504) 338-4268

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1393459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404950400000",
    "number": "1669897609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 LAKESHORE DR APT 10",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701242462",
            "telephone_number": "504-338-4268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "281 W 4TH ST",
            "city": "INDEPENDENCE",
            "state": "LA",
            "postal_code": "704432386",
            "telephone_number": "504-338-4268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-27",
        "last_updated": "2014-07-10",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "EDMOND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-338-4268",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1910864",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Georga Helmer, C.R.N.A.
• James C Hess, MD
• Kenneth Holden
• Janice Marie Holland
• Independence Family Clinic LLC
• Integrated Health and Wellness LLC
• Tymeshia Michelle Jackson
• Moritha Johnson
• Sandra J Johnson, LPC
• Miranda C Johnston, P.A.

• General Practice Physician in Independence, LA
• Providers in Independence, LA by specialty
• General Practice Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.