JCT MEDICAL/RUSSELL W. TYNES MD
NPI 1205022647
Clinic/Center - Medical Specialty in Shreveport, LA

Q: What is Jct Medical Consulting's NPI number?

The NPI number for Jct Medical Consulting is 1205022647. It was assigned to this organization in the NPPES registry on September 19, 2007. The provider is doing business as Jct Medical/Russell W. Tynes MD.

Q: What is Jct Medical Consulting's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.

Active since September 19, 2007CLIA 19D1094962 · Waiver

460 ASHLEY RIDGE BLVD STE 500, SHREVEPORT, LA 71106(318) 212-1610(866) 455-7515 Get Directions Write a Review

NPPES record last updated: April 29, 2009. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Jct Medical/russell W. Tynes Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JCT MEDICAL/RUSSELL W. TYNES MD (NPI 1205022647) is a healthcare organization registered as a medical specialty in Shreveport, Louisiana and active in the NPI registry since September 2007. The organization holds a CLIA Waiver certificate valid through January 29, 2027 and lists Russell W. Tynes, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1205022647

Entity TypeOrganization

Primary Taxonomy261QM2500X

Legal Business NameJCT MEDICAL CONSULTING

Location Address460 ASHLEY RIDGE BLVD STE 500Shreveport, LA 71106-7228

Mailing Address460 Ashley Ridge Blvd Ste 500Shreveport, LA 71106-7228 · (318) 212-1610 · Fax (866) 455-7515

Phone(318) 212-1610

Fax(866) 455-7515

Organization SubpartNo

Authorized OfficialRussell W. TynesMedical Director · (318) 212-1610

Enumeration DateSeptember 19, 2007

Last NPPES UpdateApril 29, 2009

✔ NPI 1205022647 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Medical SpecialtyAmbulatory Health Care Facilities

Taxonomy Code261QM2500X

License✔ Licensed in LA · 016884

Definition

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

460 ASHLEY RIDGE BLVD STE 500, Shreveport, LA 71106

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Other Names 1

Doing Business AsJct Medical/russell W. Tynes Md

Other Identifiers 2

Medicaid1351661LA

Medicare PIN1205022647LA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 19D1094962

Jct Medical Consulting · Shreveport, LA

Active · expires Jan 29, 2027

CLIA Number19D1094962

Laboratory TypePhysician Office

Certificate Effective DateJanuary 30, 2025

Certificate Expiration DateJanuary 29, 2027

Laboratory DirectorRussell W. Tynes MD

Laboratory Phone(318) 820-8078

Laboratory LocationJct Medical Consulting460 Ahsley Ridge Boulevard 500, Shreveport, LA 71106

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CARLA CUNNINGHAM TYNES RN

Registered Nurse (Medical-Surgical)

460 ASHLEY RIDGE BLVD STE 500
SHREVEPORT, LA 71106

Caddo Parish (318) 820-8078

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jct Medical Consulting's NPI number?

The NPI number for Jct Medical Consulting is 1205022647. It was assigned to this organization in the NPPES registry on September 19, 2007. The provider is doing business as Jct Medical/Russell W. Tynes MD.

Where is Jct Medical Consulting located?

Jct Medical Consulting is located at 460 Ashley Ridge Blvd Ste 500, Shreveport, LA 71106. The listed phone number is (318) 212-1610.

What is Jct Medical Consulting's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.

Does Jct Medical Consulting hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 19D1094962) is associated with this NPI, valid through January 29, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Jct Medical Consulting was last updated on April 29, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.