South Shreveport Internal Medicine

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SOUTH SHREVEPORT INTERNAL MEDICINE

Practice address

2508 Bert Kouns Industrial Loop
Suite 301
Shreveport, LA 71118-3133

Phone

(318) 212-5991

Fax

(318) 212-5018

NPI assigned

Jul 5, 2006

Last updated

Aug 30, 2022By 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

Greg J. Gavin

Title

Network Administrator

Phone

(318) 212-4232

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1568461572

  Member Of

  NPD member

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.

• Andrew Jao O'Young, MD

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1407884067
  Medicare reassignment NPD

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661817600000",
    "number": "1982635249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "SUITE 301",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183133",
            "telephone_number": "318-212-5991",
            "fax_number": "318-212-5018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "SUITE 301",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183133",
            "telephone_number": "318-212-5991",
            "fax_number": "318-212-5018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHREVEPORT INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A",
        "authorized_official_last_name": "GAVIN",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "NETWORK ADMINISTRATOR",
        "authorized_official_telephone_number": "318-212-4232"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1448885",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenya Leigh Soto, CCC SLP
• John Caleist Soud, DO
• South Shreve Medical Supplies, Inc.
• South Shreveport Anesthesia
• South Shreveport Family Medicine, LLC
• Southern Hills LLC (Southern Hills Healthcare & Rehabilitation)
• Southern Kidney Associates PLLC
• Southern Oaks Nursing & Rehabilitation Center, LLC (Southern Oaks Nursing & Rehabilitation Center)
• Southern Oaks Properties, LLC (Southern Oaks Nursing & Rehabilitation Center)
• Southern Pediatric Clinic

• Internal Medicine Physician in Shreveport, LA
• Providers in Shreveport, 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 Aug 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.