| South Bossier Medical | |
|
5668 Barksdale Blvd Bossier City LA 71112 | |
| (318) 735-1800 | |
| (318) 725-4960 |
| Full Name | South Bossier Medical |
|---|---|
| Speciality | Clinic/Center |
| Location | 5668 Barksdale Blvd, Bossier City, Louisiana |
| Authorized Official Name and Position | David Jones (CEO) |
| Authorized Official Contact | 3183754001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Bossier Medical 5260 Barksdale Blvd Bossier City LA 71112 Ph: () - | South Bossier Medical 5668 Barksdale Blvd Bossier City LA 71112 Ph: (318) 735-1800 |
| NPI Number | 1649993585 |
|---|---|
| Provider Enumeration Date | 09/26/2022 |
| Last Update Date | 09/30/2024 |
| Medicare PECOS PAC ID | 2567830060 |
|---|---|
| Medicare Enrollment ID | O20231128003773 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649993585 | NPI | - | NPPES |
| Provider Name | Catherine Sharpe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023493160 PECOS PAC ID: 0547565962 Enrollment ID: I20181008000463 |
| Provider Name | Summer Robin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831566777 PECOS PAC ID: 2163814617 Enrollment ID: I20220113002102 |
| Provider Name | Amber Mote |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407588627 PECOS PAC ID: 1456731330 Enrollment ID: I20220708003655 |
| Provider Name | Deborah Maureen Wynn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912527078 PECOS PAC ID: 4486090172 Enrollment ID: I20240318000036 |
| Provider Name | April Moody |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801653936 PECOS PAC ID: 6800236720 Enrollment ID: I20240425002279 |
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