NPIMap

Organization Active NPI

Shreveport Internal Medicine, LLC

  • Internal Medicine Physician
  • Shreveport, LA
National Provider Identifier
1700838513
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SHREVEPORT INTERNAL MEDICINE, LLC
Practice address
1449 E Bert Kouns Industrial Loop
Suite 100
Shreveport, LA 71105-5634
Phone
(318) 629-0220
NPI assigned
May 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Richard E. Haynie, M.D.
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

1449 E Bert Kouns Industrial Loop
Suite 100
Shreveport, LA 71105-5634

Mailing address

1449 E Bert Kouns Industrial Loop
Suite 100
Shreveport, LA 71105-5634
Phone (318) 629-0220

National Provider Directory

National Provider Directory

Locations

1449 E Bert Kouns Industrial Loop
Ste 100
Shreveport, LA 71105
Phone (318) 629-0220

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1700838513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1449 E BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "SUITE 100",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055634",
            "telephone_number": "318-629-0220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1449 E BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "SUITE 100",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055634",
            "telephone_number": "318-629-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHREVEPORT INTERNAL MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2022-07-21",
        "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_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "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 Jul 21, 2022; 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.