Healthcare Provider Details

I. General information

NPI: 1447072681
Provider Name (Legal Business Name): MCSHARMA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 TEXAS ST STE 101
SHREVEPORT LA
71101-3514
US

IV. Provider business mailing address

700 TEXAS ST STE 101
SHREVEPORT LA
71101-3514
US

V. Phone/Fax

Practice location:
  • Phone: 318-777-6843
  • Fax: 318-625-0520
Mailing address:
  • Phone: 318-777-6843
  • Fax: 318-625-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JACOB CADE MCSHARMA
Title or Position: CEO
Credential:
Phone: 318-458-6245