Leatherwood Emergency Group, LLC
Organization Active NPI Emergency Medicine Physician · Oakdale, LA
NPI 1760946313 · NPPES record last updated Mar 23, 2022
Key facts
- NPI
- 1760946313
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- Legal business name
- LEATHERWOOD EMERGENCY GROUP, LLC
- Practice address
- 130 Hospital Dr
Oakdale, LA 71463-3035 - Phone
- (318) 215-3084
- NPI assigned
- Jan 29, 2019
- Organization subpart
- No
Authorized official
- Name
- Lisha C Falk
- Title
- VP of Contracting
- Phone
- (337) 609-1221
Practitioners 43
-
Joseph D. Awotwi, M.D.
-
Cade J Burns, MD
-
Patrick Byrne, MD
-
Roderick A. Hart Sr., M.D.
-
David Mas, MD
-
David Lee Nelson, M.D.
-
Ricardo Samudia, MD
-
Rome Abdul Sherrod III, M.D.
-
David Wayne Kutob, M.D.
-
Jude A Agendia, MD
-
Praveen Budde, MD
-
Chantel K. Burns, MD
-
Gregory Lyon Glowacki, M.D.
-
Chesley Lelwynn Gregory, M.D. ,O.D.
-
Prashant Gupta, M.D.
-
Cole Hillebrandt, M.D.
-
Mark Britt Holder, M.D.
-
Kyle Lee James, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190410002335 | LA | Part B Supplier - Clinic/Group Practice | 0749521250 |
Receives reassigned benefits from 43 practitioners Practice locations: Oakdale, LA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | Yes | ||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
130 Hospital Dr
Oakdale, LA 71463-3035
Mailing address
200 Corporate Blvd
Lafayette, LA 70508-3870
Phone (800) 893-9698
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2492683 | Medicaid | LA |
Other providers in Oakdale, LA
- Joseph Christopher Kennard
- Lashonda Kirklin
- Lafleur Eye Clinic LLC
- Lake Area Home Health Agency, Inc.
- Lake Area Home Health Care, Inc.
- Kevin Scott Lejeune
- Shaquille Lewis
- Alicia Byrd Lirette
- Louisiana Physical Therapy Centers of Oakdale LLC
- Elizabeth Mancil
All providers in Oakdale, LA · Emergency Medicine Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 23, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.