Orthopaedic Clinic of Monroe
Organization Active NPI Sports Medicine (Orthopaedic Surgery) Physician · Ruston, LA
NPI 1891216263 · NPPES record last updated Jan 14, 2022
Key facts
- NPI
- 1891216263
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X
- Legal business name
- ORTHOPAEDIC CLINIC OF MONROE
- Practice address
- 1500 Commerce St
Ruston, LA 71270-5845 - Phone
- (318) 323-8451
- Fax
- (318) 361-2613
- NPI assigned
- Jul 6, 2017
- Organization subpart
- No
Authorized official
- Name
- Kevin Goldman, CFO
- Title
- Administrator
- Phone
- (318) 362-4328
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Practitioners 35
-
Solen Michael Austin, PA-C
-
John Michael Barraza, M.D.
-
Cameron M Best, M.D.
-
Robert B Bulloch, M.D.
-
Bernie M Caldwell, PA-C
-
Stanley Douglas Crawford, D.O.
-
John Allen Davis, M.D.
-
Grant Arthur Dona, M.D.
-
Jarrad W Faulk, PT
-
White Solomon Graves IV, M.D.
-
Haley Hayden, PA-C
-
Wendy Margaret Langley, PA-C
-
Blake Eugene McGehee, M.D.
-
Richmond Hayes McGough, OTR/L
-
Gregory Medlin, PT, DPT
-
Andrew Meyers, DO
-
Blake Oden, FNP, APRN
-
Jose Paragas, PT
-
Thomas Scarborough, OTR/L
-
Jodi Serpas, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170706003177 | LA | DME Supplier - Physician - Orthopedic/Orthopedic Surgery | 0840252698 | Practice locations: Ruston, LA |
National Provider Directory
- Tax ID family
- The Orthoaedic CL of Mo
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Orthopaedic Surgery) Physician |
207XX0005X | Yes |
Addresses
Primary practice location
1500 Commerce St
Ruston, LA 71270-5845
Mailing address
1501 Louisville Ave
Monroe, LA 71201-6025
Phone (318) 323-8451
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1004448 | Medicaid | LA |
Other providers in Ruston, LA
- Paul M Novakovich
- Misti Odefey
- Angela D Odom-Austin
- Winter Deleen Oliver
- Danyelle McDaniel Oneal
- David Christian Osafo
- Shequea Overall
- Ashley Elizabeth Owen
- Carolyn Owen
- Rita Katheryn Owen
All providers in Ruston, LA · Sports Medicine (Orthopaedic Surgery) 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 Jan 14, 2022. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.