Byrd Medical Clinic Inc
Organization Active NPI Family Medicine Physician · Leesville, LA
NPI 1801895495 · NPPES record last updated Aug 19, 2021
Key facts
- NPI
- 1801895495
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- BYRD MEDICAL CLINIC INC
- Practice address
- 700 S 6TH St
Leesville, LA 71446-4719 - Phone
- (337) 392-6200
- NPI assigned
- Jul 18, 2005
- Organization subpart
- No
Authorized official
- Name
- Ashley Crockett Wiley
- Title
- Mso Director
- Phone
- (337) 392-6200
Subparts reporting this organization as parent 1
Member of 1
Practitioners 48
-
Kristen Alexander, FNP-C
-
John David De Lapp, M.D.
-
Mark Jason Dominguez, M.D.
-
Paul E Howard, MD
-
Nkechinyere Christina Nwoko, D.P.M
-
Kaitlyn P Briscoe, PA-C
-
Charles M Caldwell, M.D.
-
Thomas E Dobbins, M.D.
-
Glenn R. Figueroa, M.D.
-
Robert Kenneth Lamme, M.D.
-
Kimberly Landrum, M.D.
-
Hanna G Lubbos, MD
-
Tashfeen Mahmood, M.D.
-
Reymond Meadaa, M.D.
-
Chevies Wayne Newman, M.D.
-
Heather Nelson Nortman, APRN, FNP-C
-
Kunle Ojemakinde, MD
-
Danielle Kathleen Smyth, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 19D1089861 | Byrd Medical Clinic Inc #7 | Provider-performed microscopy | Sep 28, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040921000710 | LA | Part B Supplier - Clinic/Group Practice | 2860460508 |
Receives reassigned benefits from 34 practitioners Practice locations: Deridder, LA; Rosepine, LA; Many, LA; Leesville, LA |
National Provider Directory
Locations
601 W 4th St
Dequincy, LA 70633
Phone (337) 786-6161
325 W 8th St
Deridder, LA 70634
Phone (337) 462-2262
500 S 6th St
Leesville, LA 71446
Phone (337) 239-7227
301 W Fertitta Blvd
Ste 1
Leesville, LA 71446
Phone (337) 238-0167
931 Verone Ter
Leesville, LA 71446
Phone (337) 238-0620
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | LA | Yes | |
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | |||
| Orthopaedic Surgery Physician |
207X00000X | |||
| Otolaryngology Physician |
207Y00000X | |||
| Surgery Physician |
208600000X | |||
| Urology Physician |
208800000X |
Addresses
Primary practice location
700 S 6TH St
Leesville, LA 71446-4719
Mailing address
700 S 6TH St
Leesville, LA 71446-4719
Other practice location 1
1020 W Fertitta Blvd
Leesville, LA 71446
Phone (877) 848-1457
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1944718 | Medicaid | LA |
Other providers in Leesville, LA
- Tomas Ferdinand Bryant
- Catherine Michelle Buffington
- Christopher Thomas Butler
- Byrd Emergency Group LLC
- Byrd Medical Clinic Inc
- Byrd Regional Hospital
- Calcasieu Urgent Care LLC
- Calcasieu Urgent Care LLC
- Caldwell Radiology Associates LLC
- Charles M Caldwell
All providers in Leesville, LA · Family 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 Aug 19, 2021. 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.
- 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.