MEDICARE: EMD PRIMARY CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1205706488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMD PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	1011 CHINABERRY DR STE 200
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-2438
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 CHINABERRY DR STE 200
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-2438
Country	:	US
Telephone Number	:	318-392-3372
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JOSEPH MONSOUR JR.
Credential	:
Telephone Number	:	318-250-2587

Provider Enumeration Date	:	11/11/2025
Last Update Date	:	02/12/2026

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