NPIMap

Organization Active NPI

The Plastic Surgery Center LLP

  • Plastic and Reconstructive Surgery Physician
  • Shreveport, LA
National Provider Identifier
1700929874
Registry record updated Oct 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
Legal business name
THE PLASTIC SURGERY CENTER LLP
Practice address
385 Bert Kouns Ind. Loop, BLDG 100
Shreveport, LA 71106-8124
Phone
(318) 221-1629
NPI assigned
Feb 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2007

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

Authorized official

Name
Dr. Forrest Wall, M.D.NPI 1699758474
Title
Owner
Phone
(318) 221-1629

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0122X Primary

Addresses

Primary practice location

385 Bert Kouns Ind. Loop, BLDG 100
Shreveport, LA 71106-8124

Mailing address

385 Bert Kouns Ind. Loop, BLDG 100
Shreveport, LA 71106-8124
Phone (318) 221-1629

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060120000580 LA Part B Supplier - Clinic/Group Practice 5597789297 Receives reassigned benefits from 1 practitioner
Practice locations: Shreveport, LA

National Provider Directory

National Provider Directory

Locations

385 Bert Kouns Loop
Ste 100
Shreveport, LA 71106
Phone (318) 221-1629

Practitioners & affiliated clinicians

Practitioners 4

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": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193184000000",
    "number": "1700929874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "385 BERT KOUNS IND. LOOP, BLDG 100",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711068124",
            "telephone_number": "318-221-1629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "385 BERT KOUNS IND. LOOP, BLDG 100",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711068124",
            "telephone_number": "318-221-1629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PLASTIC SURGERY CENTER LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2007-10-24",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "FORREST",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-221-1629",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "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 Oct 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.