1073861837 NPI number — JOSHUA R CASON LIMITED APMC

Table of content: JAMIE WEARY DPT, LAT, ATC (NPI 1548614555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073861837 NPI number — JOSHUA R CASON LIMITED APMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSHUA R CASON LIMITED APMC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073861837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 53032
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71135-3032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-932-2081
Provider Business Mailing Address Fax Number:
318-932-2215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 RINGGOLD AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
COUSHATTA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71019-9073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-932-2081
Provider Business Practice Location Address Fax Number:
318-932-2215
Provider Enumeration Date:
08/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CASON
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
MD/OWNER
Authorized Official Telephone Number:
318-423-4385

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  204298 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2140086 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DU2283 . This is a "RR MEDICARE GROUP" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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