Provider Demographics
NPI:1235940693
Name:MEDICAL CP
Entity type:Organization
Organization Name:MEDICAL CP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZACQULYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-840-6381
Mailing Address - Street 1:6138 GREENWOOD RD STE 500
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-8500
Mailing Address - Country:US
Mailing Address - Phone:318-840-6381
Mailing Address - Fax:
Practice Address - Street 1:6138 GREENWOOD RD STE 500
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71119-8500
Practice Address - Country:US
Practice Address - Phone:318-840-6381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier