Provider Demographics
NPI:1801805957
Name:SUSAN E. KEMP, MD, LLC
Entity type:Organization
Organization Name:SUSAN E. KEMP, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-212-0412
Mailing Address - Street 1:1801 FAIRFIELD AVE.
Mailing Address - Street 2:SUITE #304
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101
Mailing Address - Country:US
Mailing Address - Phone:318-212-0412
Mailing Address - Fax:318-212-0416
Practice Address - Street 1:1801 FAIRFIELD AVE
Practice Address - Street 2:SUITE #304
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101
Practice Address - Country:US
Practice Address - Phone:318-212-0412
Practice Address - Fax:318-212-0416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1578398Medicaid
LA1807567Medicaid
LAH67486Medicare UPIN
LA5CU72Medicare PIN