DRG MEDICAL LLC NPI 1316418288

NPI Information

NPI: 1316418288
Provider Name: DRG MEDICAL LLC

Doing Business As: GIBSON FAMILY PRACTICE

Classification: Family Medicine - 207QA0401X
Entity Type: Organization

Specialization: Addiction Medicine

CLIA Number: 19D2198123

Address:
1549 ELIZABETH AVE
SHREVEPORT, LA
ZIP 71101
Phone: (318) 918-0058
Get Directions

DRG MEDICAL LLC is an addiction medicine family medicine in Shreveport, LA. The provider is a family medicine physician who specializes in the diagnosis and treatment of addictions. DRG MEDICAL LLC NPI is 1316418288. The provider is registered as an organization entity type.
The provider Is Doing Business As Gibson Family Practice.

The provider's business location address is:

1549 ELIZABETH AVE
SHREVEPORT, LA
ZIP 71101-501
Phone: (318) 918-0058

The provider's authorized official is William Lee Gibson .
The authorized official title is Manager and has the following contact phone number (318) 918-0058.

The CLIA number assigned to this NPI record is 19D2198123 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/17/2018 and was last updated on 10/26/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			No
2	207QA0401X	Family Medicine	Addiction Medicine			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1509639	MEDICAID	LOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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