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INJURYMD LLC NPI 1104385095


NPI Information

NPI: 1104385095
Provider Name: INJURYMD, LLC
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization

CLIA Number: 19D2189606

Address:
1715 MARYCREST AVE STE 200
SHREVEPORT, LA
ZIP 71101
Phone: (318) 751-9100
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INJURYMD, LLC is a clinic center in Shreveport, LA. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). INJURYMD, LLC NPI is 1104385095. The provider is registered as an organization entity type.

The provider's business location address is:

1715 MARYCREST AVE STE 200
SHREVEPORT, LA
ZIP 71101-074
Phone: (318) 751-9100
Fax: (318) 751-9101

The provider's authorized official is Samuel David Huckabee .
The authorized official title is Coo and has the following contact phone number (318) 751-9100.

The CLIA number assigned to this NPI record is 19D2189606 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/19/2019 and was last updated on 7/29/2019.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QP2000XClinic/CenterPhysical TherapyNo
2207P00000XEmergency MedicineNo
3261Q00000XClinic/CenterYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1MD.017817OTHERLOUISIANASTATE LICENSE

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

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