WHITE CLOVER, LLC (NPI# 1104281476) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104281476 |
| Entity Type | Organization |
| Organization Name | WHITE CLOVER, LLC |
| Other Organization Name | WHITE CLOVER WELLNESS & RESEARCH CENTER |
| Practice Address |
8835 Line Ave Ste 400 Shreveport LA 71106-6730 |
| Practice Telephone | 3188614226 |
| Mailing Telephone | 3188614226 |
| Enumeration Date | 2015-12-30 |
| Last Update Date | 2015-12-30 |
| Authorized Official Name | MRS. TAMARA M SMITH (CFO) |
| Authorized Official Telephone | 3184558856 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
022377 | LA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| White Clover Wellness & Research Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164893178 | White Clover, LLC | Physician Assistant | 460 Ashley Ridge Blvd, Ste 600, Shreveport, LA 71106-7235 | 2015-10-16 |
| Street Address |
8835 LINE AVE STE 400 |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71106-6730 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972008332 | Andrew Joseph Brouillette | Dentist | 385 Bert Kouns Industrial Loop Ste 700, Shreveport, LA 71106 | 2018-03-28 |
| 1548775885 | David Wayne Spears | Pharmacist | 10460 Norris Ferry Road, Shreveport, LA 71106 | 2017-12-08 |
| 1225559263 | Susan Anderson Roblow | Physical Therapist | 921 Unadilla Street, Shreveport, LA 71106 | 2017-06-29 |
| 1134656382 | James Lowder | Dentist | 8691 Line Ave Ste 300, Shreveport, LA 71106 | 2017-05-18 |
| 1144753708 | Laverne Brantley | Counselor | 328 E 69th St, Shreveport, LA 71106 | 2017-04-10 |
| 1437690849 | Biostat Laboratories, LLC | Clinical Medical Laboratory | 9742 Saint Vincent Ave Ste 200, Shreveport, LA 71106 | 2017-03-17 |
| 1841730728 | Cedric Thomas | Case Manager/Care Coordinator | 6811 Fairfield Avenue, Shreveport, LA 71106 | 2017-02-27 |
| 1225576192 | Nick Vergis | Pharmacist | 5828 Line Avenue, Shreveport, LA 71106 | 2017-02-10 |
| 1184162554 | Marilyn Johnson | Case Manager/Care Coordinator | 9245 Wallace Lake Rd Ste A, Shreveport, LA 71106 | 2017-02-06 |
| 1417499740 | Pamela Lee | Counselor | 8802 Coyth Ln, Shreveport, LA 71106 | 2016-11-17 |
| Find all providers in zip 71106 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831331842 | Vieux Carre Investments, LLC | Internal Medicine | 8730 Youree Dr Ste B, Shreveport, LA 71115-2518 | 2009-04-06 |
| 1184720393 | Joseph L. Fredi | Internal Medicine | 1811 E Bert Kouns Industrial Loop Ste 210, Shreveport, LA 71105 | 2006-09-15 |
| 1255321881 | Michael Glen Walton | Internal Medicine | 2727 Hearne Ave, Suite 300, Shreveport, LA 71103-3917 | 2005-10-25 |
| 1760472419 | Paul Corkran Davis | Internal Medicine | 1453 E Bert Koun Loop Ste 112, Shreveport, LA 71105-6810 | 2005-10-25 |
| 1801886585 | Robert Tate Martin | Internal Medicine | 1811 E Bert Kouns Industrial Loop # 210, Shreveport, LA 71105 | 2005-10-25 |
| 1669472155 | Sanders Fowler Hearne | Internal Medicine | 1811 E Bert Kouns, Suite 100, Shreveport, LA 71115 | 2005-07-26 |
| 1588664080 | William Howard Haynie Jr. | Internal Medicine | 1453 E Bert Koun Loop, Ste 112, Shreveport, LA 71105-6800 | 2005-07-26 |
| 1881127090 | Advanced Cardiovascular Specialists | Internal Medicine | 1453 E Bert Koun Loop, Ste 112, Shreveport, LA 71105-6800 | 2017-04-05 |
| 1972043511 | Wk Heart and Vascular Institute Chf Clinic | Internal Medicine | 2727 Hearne Ave, Shreveport, LA 71103-3917 | 2017-03-01 |
| 1063963189 | Basel Kasabali Md Apmc | Internal Medicine | 1800 Irving Pl, Shreveport, LA 71101-4608 | 2016-10-24 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71106 |
Please comment or provide details below to improve the information on WHITE CLOVER, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.