Healthcare Provider Details

I. General information

NPI: 1952531170
Provider Name (Legal Business Name): CARDINAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8625 LINE AVE STE E
SHREVEPORT LA
71106-6107
US

IV. Provider business mailing address

8625 LINE AVE STE E
SHREVEPORT LA
71106-6107
US

V. Phone/Fax

Practice location:
  • Phone: 318-935-6177
  • Fax: 888-935-4748
Mailing address:
  • Phone: 318-935-6177
  • Fax: 888-935-4748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13289R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number13289R
License Number StateLA

VIII. Authorized Official

Name: RICHARD THOMAS SIPES
Title or Position: OWNER
Credential: M.D.
Phone: 318-935-6177