Integra Health Services Professional Corporation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD.11956R Issued in LA

Legal business name

INTEGRA HEALTH SERVICES PROFESSIONAL CORPORATION

Practice address

1110 Ringgold Ave Ste B
Coushatta, LA 71019-9004

Phone

(318) 798-4606

Fax

(318) 798-4601

NPI assigned

Jul 25, 2017

Last updated

Mar 17, 2018By 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

Dr. Gavin F Chico, MDNPI 1740261650

Title

MD/Owner

Phone

(318) 780-6230

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gavin F Chico, M. D.

  • Internal Medicine Physician
  • Coushatta, LA
  • NPI 1740261650
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1500940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1861915415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 53032",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711353032",
            "telephone_number": "318-798-4606",
            "fax_number": "318-798-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 RINGGOLD AVE STE B",
            "city": "COUSHATTA",
            "state": "LA",
            "postal_code": "710199004",
            "telephone_number": "318-798-4606",
            "fax_number": "318-798-4601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4900 Medical Dr",
            "address_purpose": "LOCATION",
            "city": "Bossier City",
            "state": "LA",
            "postal_code": "711124521",
            "country_code": "US",
            "telephone_number": "318-798-4606",
            "fax_number": "318-798-4601",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1110 Ringgold Ave",
            "address_purpose": "LOCATION",
            "city": "Coushatta",
            "state": "LA",
            "postal_code": "710199000",
            "country_code": "US",
            "telephone_number": "318-798-4606",
            "fax_number": "318-798-4601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTEGRA HEALTH SERVICES PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-25",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "CHICO",
        "authorized_official_first_name": "GAVIN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "318-780-6230",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": "LA",
            "license": "MD.11956R",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "MD.11956R",
            "primary": true
        },
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "LA",
            "license": "MD.11956R",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sarah Herbel, MD
• Richard David Holcombe, PT, OCS
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• Erikka Johnson
• Joshua R Cason Limited Apmc
• Ben Jowers, PHARMACIST

• Internal Medicine Physician in Coushatta, LA
• Providers in Coushatta, LA by specialty
• Internal Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.