MILLS CLINIC A PROFESSIONAL MEDICAL CORPORATION (NPI# 1649328030) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649328030 |
| Entity Type | Organization |
| Organization Name | MILLS CLINIC A PROFESSIONAL MEDICAL CORPORATION |
| Practice Address |
7225 Fern Avenue Suite 600 Shreveport LA 71105-4981 |
| Practice Telephone | 3186293630 |
| Practice Fax Number | 3186293640 |
| Mailing Telephone | 3186293630 |
| Mailing Fax Number | 3186293640 |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2008-10-14 |
| Authorized Official Name | DR. BRYAN HAYWOOD MILLS (MD OWNER PRESIDENT) |
| Authorized Official Telephone | 3186293630 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1989088 | 05 | |
| CLIA | 19D1047971 | 01 |
| Street Address |
7225 FERN AVENUE SUITE 600 |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71105-4981 |
| 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 | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205457645 | Perfect Phyzique Wellness & Body Contouring, LLC | Clinic/Center | 220 Carroll St Ste A, Shreveport, LA 71105-4247 | 2020-04-27 |
| 1639798291 | Sick Day Rx LLC | Clinic/Center | 817 Ardennes Ct, Shreveport, LA 71115-4613 | 2020-04-14 |
| 1376191627 | Integrity Family Medicine Clinic LLC | Clinic/Center | 1800 Buckner St Ste A120, Shreveport, LA 71101-4440 | 2019-08-29 |
| 1316418288 | Drg Medical LLC | Clinic/Center | 1549 Elizabeth Ave, Shreveport, LA 71101-4501 | 2018-12-17 |
| 1275075129 | Neil Halim Fairfield Family Clinic | Clinic/Center | 1860 Fairfield Ave, Shreveport, LA 71101-4431 | 2016-11-09 |
| 1952761686 | Jonah Healthcare, A Professional Medical Corporation | Clinic/Center | 2328 Line Ave, Shreveport, LA 71104-2131 | 2016-02-23 |
| 1528432440 | Southern Pediatric Clinic | Clinic/Center | 202 N Thomas Dr, Suite 1, Shreveport, LA 71107-6539 | 2015-11-16 |
| 1649644675 | Sarah C Hamauei, Md, LLC | Clinic/Center | 2133 E Bert Kouns Industrial Loop, Shreveport, LA 71105-5314 | 2015-11-13 |
| 1508237256 | Southern Pediatric Clinic | Clinic/Center | 4571 N Market St, Shreveport, LA 71107-2917 | 2015-10-07 |
| 1992111793 | Arterberry Family Care Center | Clinic/Center | 865 Olive St, Shreveport, LA 71104-2136 | 2014-07-01 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71105 |
Please comment or provide details below to improve the information on MILLS CLINIC A PROFESSIONAL MEDICAL CORPORATION.
| 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.