Southern Rehab & Medical Center

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

SOUTHERN REHAB & MEDICAL CENTER

Practice address

2207 California Dr
Ste. 9a
Bossier City, LA 71111-3571

Phone

(318) 747-6118

NPI assigned

Oct 16, 2006

Last updated

Jun 27, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Kenneth James Leach

Title

President

Phone

(504) 456-6844

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372291200000",
    "number": "1861572794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2207 CALIFORNIA DR",
            "address_2": "STE. 9A",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711113571",
            "telephone_number": "318-747-6118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2207 CALIFORNIA DR",
            "address_2": "STE. 9A",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711113571",
            "telephone_number": "318-747-6118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN REHAB & MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2013-06-27",
        "status": "A",
        "authorized_official_last_name": "LEACH",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "504-456-6844",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1431478",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "F7457",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.