SOUTHERN KIDNEY ASSOCIATES PLLC (NPI# 1194292516) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194292516 |
| Entity Type | Organization |
| Organization Name | SOUTHERN KIDNEY ASSOCIATES PLLC |
| Practice Address |
1815 E 70th St Shreveport LA 71105-5301 |
| Mailing Address |
1402 N 4th St Longview TX 75601-4774 |
| Practice Telephone | 8002769017 |
| Practice Fax Number | 9032349992 |
| Mailing Telephone | 9032349992 |
| Mailing Fax Number | 9032348287 |
| Enumeration Date | 2018-10-24 |
| Last Update Date | 2018-12-07 |
| Authorized Official Name | SARA WOLF (ADMINISTRATOR) |
| Authorized Official Telephone | 9032349992 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians |
| Street Address |
1815 E 70TH ST |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71105-5301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215121330 | Total Renal Care Inc | Clinic/Center | 1815 E 70th St, Shreveport, LA 71105-5301 | 2007-08-31 |
| 1821603465 | Todd Campbell | Physician Assistant | 1815 E 70th St, Shreveport, LA 71105-5301 | 2020-09-10 |
| 1912248931 | Total Renal Care Inc | Clinic/Center | 1815 E 70th St, Shreveport, LA 71105-5301 | 2013-03-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699245928 | Misty Johnetta Ross | Counselor | 2942 Knight St., Bldg. 4 Suite 426, Shreveport, LA 71105 | 2018-11-29 |
| 1205301868 | Tatjhana Maury | Case Manager/Care Coordinator | 3325 Youree Drive, Shreveport, LA 71105 | 2018-10-10 |
| 1245710920 | Jefferey Douglas Adair Md | Non-Pharmacy Dispensing Site | 8860 Fern Ave., Suite 120, Shreveport, LA 71105 | 2018-08-21 |
| 1679059539 | Michael E Woolbert Dds LLC | Dentist | 7600 Fern Avenue, Building 1100, Shreveport, LA 71105 | 2018-07-13 |
| 1881195675 | Adiba Bibi | Pharmacist | 3555 Greenwood Road, Walgreens, Shreveport, LA 71105 | 2018-02-27 |
| 1740796655 | Allison Borel | Counselor | 2020 E 70th St Ste 201, Shreveport, LA 71105 | 2017-12-15 |
| 1073028148 | Valerie Wooten Barcelona | Physical Therapist | 130 Kayla Street, Shreveport, LA 71105 | 2017-12-11 |
| 1710497615 | Jimmy Carroll | Counselor | 2960 Knight St, Suite 110, Shreveport, LA 71105 | 2017-10-05 |
| 1932618444 | David Louis Bennett | Counselor | 3007 Knight St., Suite 200, Shreveport, LA 71105 | 2017-09-27 |
| 1619496452 | Shaqwana Hodge | Counselor | 2920 Knight St. Suite 110, Shreveport, LA 71105 | 2017-09-13 |
| Find all providers in zip 71105 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://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 |
|---|---|---|---|---|
| 1346675188 | Srijan Tandukar | Internal Medicine | 2751 Albert L Bicknell Dr Ste 2b, Shreveport, LA 71103 | 2013-09-12 |
| 1093919920 | Neeraj Singh | Internal Medicine | 2751 Albert L Bicknell Dr Fl 4, Shreveport, LA 71103 | 2007-06-13 |
| 1629187422 | John Stephen Kilpatrick | Internal Medicine | 745 Olive St Ste 207, Shreveport, LA 71104-2250 | 2006-08-29 |
| 1831184407 | Marwan Kaskas | Internal Medicine | 2501 Greenwood Rd, Shreveport, LA 71103-3905 | 2005-09-20 |
| 1710972559 | Arnold E Barz | Internal Medicine | 1800 Buckner St, Suite C120, Shreveport, LA 71101-4440 | 2005-09-19 |
| 1447242680 | Henry Edward Wood Jr. | Internal Medicine | 745 Olive St, Ste 200, Shreveport, LA 71104-2246 | 2005-08-15 |
| 1083615520 | Marisa Johnson | Internal Medicine | 1303 Line Ave, Ste 400, Shreveport, LA 71101-4628 | 2005-08-09 |
| 1356713440 | Delta Nephrology LLC | Internal Medicine | 745 Olive St, Suite 200, Shreveport, LA 71104-2246 | 2015-10-28 |
| 1386013670 | John S Kilpatrick Md A Professional Medical Corporation | Internal Medicine | 745 Olive St Ste 207, Shreveport, LA 71104-2250 | 2015-09-17 |
| 1295123644 | Melissa L Lynn Md Apmc | Internal Medicine | 2751 Albert L Bicknell Dr, Suite 3c, Shreveport, LA 71103-3920 | 2015-01-07 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71105 |
Please comment or provide details below to improve the information on SOUTHERN KIDNEY ASSOCIATES PLLC.
| 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.