Provider Demographics
NPI:1255680724
Name:VELOCITY MD LLC
Entity Type:Organization
Organization Name:VELOCITY MD LLC
Other - Org Name:VELOCITY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ URGENT CARE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:318-629-3763
Mailing Address - Street 1:PO BOX 15673
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61132-5673
Mailing Address - Country:US
Mailing Address - Phone:815-713-2600
Mailing Address - Fax:815-654-8020
Practice Address - Street 1:9300 MANSFIELD RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3137
Practice Address - Country:US
Practice Address - Phone:318-629-3763
Practice Address - Fax:318-629-3767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care