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JCT MEDICAL CONSULTING NPI 1205022647


NPI Information

NPI: 1205022647
Provider Name: JCT MEDICAL CONSULTING

Doing Business As: JCT MEDICAL/RUSSELL W. TYNES MD

Classification: Clinic/Center - 261QM2500X
Entity Type: Organization

Specialization: Medical Specialty

CLIA Number: 19D1094962

Address:
460 ASHLEY RIDGE BLVD STE 500
SHREVEPORT, LA
ZIP 71106
Phone: (318) 212-1610
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JCT MEDICAL CONSULTING is a medical specialty clinic center in Shreveport, LA. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). JCT MEDICAL CONSULTING NPI is 1205022647. The provider is registered as an organization entity type.
The provider Is Doing Business As Jct Medical/russell W. Tynes Md.

The provider's business location address is:

460 ASHLEY RIDGE BLVD STE 500
SHREVEPORT, LA
ZIP 71106-228
Phone: (318) 212-1610
Fax: (866) 455-7515

The provider's authorized official is Russell W. Tynes .
The authorized official title is Medical Director and has the following contact phone number (318) 212-1610.

The CLIA number assigned to this NPI record is 19D1094962 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/19/2007 and was last updated on 4/29/2009.


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
1261QM2500XClinic/CenterMedical Specialty016884LOUISIANAYes

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
11351661MEDICAIDLOUISIANA
21205022647MEDICARE PINLOUISIANA

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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