Provider Demographics
NPI:1447072681
Name:MCSHARMA MEDICAL LLC
Entity type:Organization
Organization Name:MCSHARMA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:CADE
Authorized Official - Last Name:MCSHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-458-6245
Mailing Address - Street 1:700 TEXAS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3514
Mailing Address - Country:US
Mailing Address - Phone:318-777-6843
Mailing Address - Fax:318-625-0520
Practice Address - Street 1:700 TEXAS ST STE 101
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3514
Practice Address - Country:US
Practice Address - Phone:318-777-6843
Practice Address - Fax:318-625-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty