HARRIS MEMORIAL PEDIATRIC & FAMILY CLINIC (NPI# 1619353802) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619353802 |
| Entity Type | Organization |
| Organization Name | HARRIS MEMORIAL PEDIATRIC & FAMILY CLINIC |
| Practice Address |
4571 N Market St Shreveport LA 71107-2917 |
| Mailing Address |
Po Box 7312 Shreveport LA 71137-7312 |
| Practice Telephone | 3189340097 |
| Practice Fax Number | 3189340097 |
| Mailing Telephone | 3182054075 |
| Mailing Fax Number | 3187544134 |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2015-08-10 |
| Authorized Official Name | MR. RICHARD L JACKSON (CHEIF EXECUTIVE OFFICE) |
| Authorized Official Telephone | 3182054075 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305S00000X | Point of Service | Managed Care Organizations |
| Street Address |
4571 N MARKET ST |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71107-2917 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336168020 | Catrell J. Mcculloch | Pediatrics | 4571 N Market St, Shreveport, LA 71107-2917 | 2006-07-19 |
| 1710525738 | Tierra Demming | Case Manager/Care Coordinator | 4571 N Market St, Shreveport, LA 71107-2917 | 2019-12-20 |
| 1326699208 | Shamkea Dixon | Case Manager/Care Coordinator | 4571 N Market St, Shreveport, LA 71107-2917 | 2019-09-23 |
| 1659922524 | Johnna Williams | Case Manager/Care Coordinator | 4571 N Market St, Shreveport, LA 71107-2917 | 2019-09-23 |
| 1245889138 | Niara Talton | Case Manager/Care Coordinator | 4571 N Market St, Shreveport, LA 71107-2917 | 2019-09-04 |
| 1770135626 | Kadavion Evans | Case Manager/Care Coordinator | 4571 N Market St, Shreveport, LA 71107-2917 | 2019-07-11 |
| 1548824493 | Pam Peters | Case Manager/Care Coordinator | 4571 N Market St, Shreveport, LA 71107-2917 | 2019-04-25 |
| 1275197121 | Demetrial Houston | Case Manager/Care Coordinator | 4571 N Market St, Shreveport, LA 71107-2917 | 2019-04-25 |
| 1326499922 | Teriana Pierre | Social Worker | 4571 N Market St, Shreveport, LA 71107-2917 | 2016-06-24 |
| 1528415783 | Yomeka M Evans | Case Manager/Care Coordinator | 4571 N Market St, Shreveport, LA 71107-2917 | 2016-05-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306490875 | Kimber Leigh Lumley | Registered Nurse | 1440 Hawn Ave., Shreveport, LA 71107 | 2019-08-01 |
| 1871063461 | Nicole Capito | Case Manager/Care Coordinator | 200 North Thomas Drive Ste 1, Shreveport, LA 71107 | 2018-11-27 |
| 1891260899 | Danielle Leigh Dreher | Dental Assistant | 3610 Gorman Rd, Shreveport, LA 71107 | 2018-10-05 |
| 1255817540 | Shirley Marie Washington | Technician | 3227 Old Mooringsport Rd., Shreveport Rd, LA 71107 | 2018-07-19 |
| 1366928467 | Katrina L Bailey | Case Manager/Care Coordinator | 1111 Hawn Ave Apt A, Shreveport, LA 71107 | 2018-07-12 |
| 1063907970 | James Mcneely IIi | Public Health or Welfare | 5922 Alaska Ln, Shreveport, LA 71107 | 2018-06-25 |
| 1528560067 | Jacarie Guice | Case Manager/Care Coordinator | 4601 N. Market Ste 2, Shreveport, LA 71107 | 2018-03-01 |
| 1467971069 | Tracy Renard Harris | Counselor | 1149 Englemeade Dr, Shreveport, LA 71107 | 2017-09-14 |
| 1427588045 | Mark Rogers | Behavior Technician | 1500 N. Market Unit C Suite 105, Shreveport, LA 71107 | 2017-06-15 |
| 1356871164 | Hope4youth | Voluntary or Charitable | 2850 King Oaks Loop, Shreveport, LA 71107 | 2017-06-14 |
| Find all providers in zip 71107 | ||||
| Taxonomy Code | 305S00000X |
| Grouping | Managed Care Organizations |
| Classification | Point of Service |
| This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 62 |
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| Find all providers with the same taxonomy | ||||
| City | SHREVEPORT |
| Zip Code | 71107 |
Please comment or provide details below to improve the information on HARRIS MEMORIAL PEDIATRIC & FAMILY CLINIC.
| 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.