NPIMap

Organization Active NPI

Tri-State Medical Clinic, Apmc

  • Internal Medicine Physician
  • Shreveport, LA
National Provider Identifier
1679520027
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
TRI-STATE MEDICAL CLINIC, APMC
Practice address
2551 Greenwood Rd
Suite 410
Shreveport, LA 71103-3981
Phone
(318) 621-2929
NPI assigned
May 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Richard E. Haynie, MD
Title
President
Phone
(318) 621-2929

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X LA Primary

Addresses

Primary practice location

2551 Greenwood Rd
Suite 410
Shreveport, LA 71103-3981

Mailing address

2551 Greenwood Rd
Suite 410
Shreveport, LA 71103-3981
Phone (318) 621-2929

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679520027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2551 GREENWOOD RD",
            "address_2": "SUITE 410",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033981",
            "telephone_number": "318-621-2929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2551 GREENWOOD RD",
            "address_2": "SUITE 410",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033981",
            "telephone_number": "318-621-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE MEDICAL CLINIC, APMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HAYNIE",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "318-621-2929",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Aug 22, 2020; 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.