Charles L. Black Jr MD Surgical Clinic Corp

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

011576 Issued in LA

Legal business name

CHARLES L. BLACK JR MD SURGICAL CLINIC CORP

Practice address

1534 Elizabeth Ave
Suite 202
Shreveport, LA 71101-4516

Phone

(318) 221-0166

NPI assigned

Feb 12, 2007

Last updated

Sep 14, 2007By 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

Charles Lester Black Jr., M.D.NPI 1992744981

Title

Owner

Phone

(318) 221-0166

Specialties & licenses 1

Addresses

Other identifiers 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.

• Charles Black, M.D.

  • Surgery Physician
  • Shreveport, LA
  • NPI 1992744981
  NPD (past) Authorized official

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189728000000",
    "number": "1952442832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1534 ELIZABETH AVE",
            "address_2": "SUITE 202",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014516",
            "telephone_number": "318-221-0166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1534 ELIZABETH AVE",
            "address_2": "SUITE 202",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014516",
            "telephone_number": "318-221-0166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES L. BLACK JR MD SURGICAL CLINIC CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2007-09-14",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "LESTER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-221-0166",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "LA",
            "license": "011576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1169838",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cloteal Chapple
• Dana Lynn Charbonneau, MCD/CCC-SLP
• John Charles Charity, NP-BC
• Charles E Lyon, MD, Apmc
• Charles Hargon MD and Willis-Knighton Medical Center
• Charles P. Werner, MD Apmc
• Charles R. Byrd MD a Professional
• Charles Sale MD and Willis-Knighton Medical Center
• Fabia Charles
• Keely Charles

• Surgery Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Surgery Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2007; 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.