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MILLS CLINIC A PROFESSIONAL MEDICAL CORPORATION NPI 1649328030


NPI Information

NPI: 1649328030
Provider Name: MILLS CLINIC A PROFESSIONAL MEDICAL CORPORATION
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 19D1047971

Address:
7225 FERN AVENUE
SUITE 600
SHREVEPORT, LA
ZIP 71105
Phone: (318) 629-3630
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MILLS CLINIC A PROFESSIONAL MEDICAL CORPORATION is a primary care clinic center in Shreveport, LA. MILLS CLINIC A PROFESSIONAL MEDICAL CORPORATION NPI is 1649328030. The provider is registered as an organization entity type.

The provider's business location address is:

7225 FERN AVENUE
SUITE 600
SHREVEPORT, LA
ZIP 71105-981
Phone: (318) 629-3630
Fax: (318) 629-3640

The provider's authorized official is Bryan Haywood Mills .
The authorized official title is Md Owner President and has the following contact phone number (318) 629-3630.

The CLIA number assigned to this NPI record is 19D1047971 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 1/8/2007 and was last updated on 10/14/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QP2300XClinic/CenterPrimary CareYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11989088MEDICAIDLOUISIANA
219D1047971OTHERCLIA
35CT15MEDICARE ID-TYPE UNSPECIFIEDLOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.