Provider Demographics
NPI:1821034679
Name:SUREACCESS, MD, LLC
Entity Type:Organization
Organization Name:SUREACCESS, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-935-6177
Mailing Address - Street 1:725 N ASHLEY RIDGE LOOP
Mailing Address - Street 2:#100
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7232
Mailing Address - Country:US
Mailing Address - Phone:318-935-6177
Mailing Address - Fax:888-627-6744
Practice Address - Street 1:725 N ASHLEY RIDGE LOOP
Practice Address - Street 2:#100
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7232
Practice Address - Country:US
Practice Address - Phone:318-935-6177
Practice Address - Fax:888-627-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13626R207R00000X, 208000000X
LA14448R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CU49Medicare PIN