NPIMap

Organization Active NPI

Snells Limbs & Braces of Shreveport LLC

  • Prosthetic/Orthotic Supplier
  • Shreveport, LA
National Provider Identifier
1851442503
Registry record updated Nov 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
SNELLS LIMBS & BRACES OF SHREVEPORT LLC
Practice address
1833 Line Ave
Shreveport, LA 71101-4611
Phone
(318) 424-4167
NPI assigned
Jan 16, 2007
Last updated
Nov 15, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2012

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

Authorized official

Name
Mr. Clyde N. Massey, C.P.O.
Title
Vice President
Phone
(318) 424-4167

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

1833 Line Ave
Shreveport, LA 71101-4611

Mailing address

1833 Line Ave
Shreveport, LA 71101-4611
Phone (318) 424-4167

Other identifiers 2

IdentifierTypeStateIssuer
1017710MedicaidLA
78361OtherLABLUECROSS OF LA PROVIDER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930050779 LA DME Supplier - Medical Supply Company With Orthotic-ProstheticDME Supplier - Orthotic PersonnelDME Supplier - Prosthetic Personnel 7618094657 Practice locations: Shreveport, LA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Snells Limbs & Braces of Shre1833 Line Ave, Shreveport, LA 71101-4611(318) 424-4167 Canes and/or Crutches|Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Lymphedema Compression Treatment Items Does not accept assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Snells Limb and Braces3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1833 Line Ave
Shreveport, LA 71101
Phone (318) 424-4167

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352937600000",
    "number": "1851442503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1833 LINE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014611",
            "telephone_number": "318-424-4167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1833 LINE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014611",
            "telephone_number": "318-424-4167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SNELLS LIMBS & BRACES OF SHREVEPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2012-11-15",
        "status": "A",
        "authorized_official_last_name": "MASSEY",
        "authorized_official_first_name": "CLYDE",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "318-424-4167",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "C.P.O."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1017710",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS OF LA PROVIDER",
            "identifier": "78361",
            "state": "LA"
        }
    ],
    "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 Nov 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.