MEDICARE: MCSHARMA MEDICAL LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	363A00000X	Physician Assistant
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1447072681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCSHARMA MEDICAL LLC

Provider Business Mailing Address
First Line	:	700 TEXAS ST STE 101
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-3514
Country	:	US
Telephone Number	:	318-777-6843
Fax Number	:	318-625-0520

Provider Business Practice Location Address
First Line	:	700 TEXAS ST STE 101
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-3514
Country	:	US
Telephone Number	:	318-777-6843
Fax Number	:	318-625-0520

Authorized Official
Title or Position	:	CEO
Name	:	MR. JACOB CADE MCSHARMA
Credential	:
Telephone Number	:	318-458-6245

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	10/29/2024

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Directions to “MCSHARMA MEDICAL LLC ” Practice Location

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