NPIMap

Organization Active NPI

Gentry Haughton, LLC

  • Podiatrist
  • Shreveport, LA
National Provider Identifier
1881009595
Registry record updated Nov 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
DPM.200048 Issued in LA
Legal business name
GENTRY HAUGHTON, LLC
Practice address
1505 E Bert Koun Loop
Suite 101
Shreveport, LA 71105-5723
Phone
(318) 519-7555
NPI assigned
Jun 23, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2019

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

Authorized official

Name
Gentry Lee HaughtonNPI 1316171358
Title
DPM
Phone
(318) 519-7555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X DPM.200048 LA Primary

Addresses

Primary practice location

1505 E Bert Koun Loop
Suite 101
Shreveport, LA 71105-5723

Mailing address

PO Box 5237
Shreveport, LA 71135-5237
Phone (318) 798-4539

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141024000571 LA Part B Supplier - Clinic/Group Practice 2062633688 Receives reassigned benefits from 2 practitioners
Practice locations: Monroe, LA; Zwolle, LA; West Monroe, LA; Shreveport, LA; Minden, LA; Mansfield, LA; Coushatta, LA; Bossier City, LA

National Provider Directory

National Provider Directory
Tax ID family
Gentry Haughton2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

3130 Arthur Ray Teague Pkwy
Bossier City, LA 71112
Phone (318) 741-2763

635 Schley St
Mansfield, LA 71052
Phone (318) 871-0402

2301 Sterlington Rd
Monroe, LA 71203
Phone (318) 323-3426

7060 Cottonwood Blvd
Shreveport, LA 71129
Phone (318) 631-1846

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1403481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573084800000",
    "number": "1881009595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5237",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711355237",
            "telephone_number": "318-798-4539",
            "fax_number": "318-798-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 E BERT KOUN LOOP",
            "address_2": "SUITE 101",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055723",
            "telephone_number": "318-519-7555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENTRY HAUGHTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-23",
        "last_updated": "2019-11-07",
        "status": "A",
        "authorized_official_last_name": "HAUGHTON",
        "authorized_official_first_name": "GENTRY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "DPM",
        "authorized_official_telephone_number": "318-519-7555"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "LA",
            "license": "DPM.200048",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 7, 2019; 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.