| Cody Tingle Md Llc | |
|
535 Pierremont Rd Shreveport LA 71106-2207 | |
| (318) 208-1804 | |
| Not Available |
| Full Name | Cody Tingle Md Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 535 Pierremont Rd, Shreveport, Louisiana |
| Authorized Official Name and Position | Cody Tingle (PHYSICIAN) |
| Authorized Official Contact | 3182081804 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cody Tingle Md Llc Po Box 19284 Shreveport LA 71149-0284 Ph: (318) 773-0657 | Cody Tingle Md Llc 535 Pierremont Rd Shreveport LA 71106-2207 Ph: (318) 208-1804 |
| NPI Number | 1790315026 |
|---|---|
| Provider Enumeration Date | 01/26/2020 |
| Last Update Date | 01/26/2020 |
| Medicare PECOS PAC ID | 4082044169 |
|---|---|
| Medicare Enrollment ID | O20200414002811 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790315026 | NPI | - | NPPES |
| 2189328 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Cody M Tingle |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699031237 PECOS PAC ID: 0749597342 Enrollment ID: I20150915000938 |
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