Active NPI
Fred A. Lord Jr., CRNA
- Certified Registered Nurse Anesthetist
- Shreveport, LA
National Provider Identifier
1679792014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 033348
- Practice address
- 745 Olive St
Suite 100
Shreveport, LA 71104-2246 - Phone
- (318) 227-1163
- Fax
- (318) 227-0413
- NPI assigned
- Apr 24, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 033348 | LA | Primary |
Addresses
Primary practice location
745 Olive St
Suite 100
Shreveport, LA 71104-2246
Mailing address
243 Scarlett PVT Dr
Gloster, LA 71030
Phone (318) 925-5826
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1399370 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 033348 | LA | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shreveport Surgery Center Ptrshp | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Ambulatory Surgical Clinic/Center
- Shreveport, LA
- NPI 1598804486
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679792014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "243 SCARLETT PVT DR",
"city": "GLOSTER",
"state": "LA",
"postal_code": "71030",
"telephone_number": "318-925-5826"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "745 OLIVE ST",
"address_2": "SUITE 100",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711042246",
"telephone_number": "318-227-1163",
"fax_number": "318-227-0413"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LORD",
"first_name": "FRED",
"middle_name": "A.",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "LA",
"license": "033348",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1399370",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.