West Chandler, MD
Individual provider Active NPI Family Medicine Physician · Marshall, TX
NPI 1790928232 · NPPES record last updated Sep 23, 2013
Key facts
- NPI
- 1790928232
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- P4939 (TX)
- Practice address
- 620 S Grove St
Suite 105
Marshall, TX 75670-5269 - Phone
- (903) 934-5280
- Fax
- (903) 934-5481
- NPI assigned
- Apr 14, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Louisiana State University School of Medicine in Shreveport, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- WK Urgent Care Center-Pierremont
Practice addresses (Care Compare)
1666 E Bert Kouns Industrial Loop
Suite 105
Shreveport, LA 71105-5718
Phone (318) 212-3520
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of nail tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140130001277 | LA | Practitioner - Family Practice | 1557511037 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 204837 | LA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| WK Urgent Care Center-Pierremont | Family Medicine | Current |
Accepting new patients |
| East Texas Border Health Clinic | Family Medicine | Past | Accepting new patients |
Locations
2300 Hospital Dr
Ste 180
Bossier City, LA 71111
Phone (318) 212-7520
5751 Shed Rd
Ste 100
Bossier City, LA 71111
Phone (318) 935-1900
2600 Greenwood Rd
Shreveport, LA 71103
Phone (318) 212-4600
2520 Bert Kouns Industrial Loop
Shreveport, LA 71118
9460 Ellerbe Rd
Ste 140
Shreveport, LA 71106
Phone (318) 213-7070
1666 E Bert Kouns Industrial Loop
Ste 105
Shreveport, LA 71105
Phone (318) 212-3520
2520 Bert Kouns Industrial Loop
Ste 105
Shreveport, LA 71118
Phone (318) 212-5520
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 204837 | LA | |
| Family Medicine Physician | 207Q00000X | P4939 | TX | Yes |
Addresses
Primary practice location
620 S Grove St
Suite 105
Marshall, TX 75670-5269
Mailing address
PO Box 1325
Marshall, TX 75671-1325
Phone (903) 934-5280
Other providers in Marshall, TX
- Latonya Carter
- Casce House
- Shannon Marie Cash
- John Carrell Cayce
- Kendall Yazzie Redhorse Chambellan
- Changing Lives Behavioral Health
- Jeri Kellett Charles
- Toney Lee Charles Jr.
- Choices Adolescent Treatment Ctr
- Christus Good Shepherd Medical Center
All providers in Marshall, TX · Family Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2013. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.