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NOVA VITAL IOP LLC
NPI 1477242196
Clinic/Center - Rehabilitation, Substance Use Disorder in Shreveport, LA

Active since May 08, 2023CLIA 19D2287261 · Waiver
850 MARGARET PL, SHREVEPORT, LA 71101(318) 268-6101 Get Directions Write a Review

NPPES record last updated: April 5, 2024. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Apr 5, 2024, May 8, 2023 (2 updates tracked since 2023).

About Nova Vital Iop Llc NPPES

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

NOVA VITAL IOP LLC (NPI 1477242196) is a healthcare organization registered as a rehabilitation, substance use disorder in Shreveport, Louisiana and active in the NPI registry since May 2023. The organization holds a CLIA Waiver certificate valid through August 10, 2027 and lists Mallory Macisaac, Controller, as its authorized official.

NPPES Registry Identity

NPI1477242196
Entity TypeOrganization
Primary Taxonomy261QR0405X
Legal Business NameNOVA VITAL IOP LLC
Location Address850 MARGARET PLShreveport, LA 71101-4521
Mailing Address8520 Business Park DrShreveport, LA 71105-5654 · (318) 268-6101
Phone(318) 268-6101
Organization SubpartNo
Authorized OfficialMallory MacisaacController · (318) 268-6101
Enumeration DateMay 8, 2023
Last NPPES UpdateApril 5, 20242 updates tracked since enumeration
NPPES CertifiedApril 5, 2024
✔ NPI 1477242196 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Rehabilitation, Substance Use DisorderAmbulatory Health Care Facilities
Taxonomy Code261QR0405X
850 MARGARET PL, Shreveport, LA 71101
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Louisiana, HMO Louisiana.Insurance ›

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 19D2287261

Nova Vital Iop, LLC · Shreveport, LA
Active · expires Aug 10, 2027
CLIA Number19D2287261
Laboratory TypeOp Counseling Cntr
Certificate Effective DateAugust 11, 2025
Certificate Expiration DateAugust 10, 2027
Laboratory DirectorRandy Davis
Laboratory Phone(318) 268-6101
Laboratory LocationNova Vital Iop, LLC3007 Knight Street Suite 300B, Shreveport, LA 71105
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

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

MR. LAWRENCE J DREXLER MD
Internal Medicine (Geriatric Medicine)
850 MARGARET PL
SHREVEPORT, LA 71101
Caddo Parish (318) 222-8187
BLUEFIN MEDICAL, LLC
Family Medicine (Addiction Medicine)
850 MARGARET PL
SHREVEPORT, LA 71101
Caddo Parish (318) 208-2000
THOMAS A REILLY MD APMC
Internal Medicine (Geriatric Medicine)
850 MARGARET PL
SHREVEPORT, LA 71101
Caddo Parish (318) 222-8187
SHREVEPORT GERIATRICS
Family Medicine (Geriatric Medicine)
850 MARGARET PL
SHREVEPORT, LA 71101
Caddo Parish (318) 222-8187
SHREVEPORT GERIATRICS
Internal Medicine (Geriatric Medicine)
850 MARGARET PL
SHREVEPORT, LA 71101
Caddo Parish (318) 222-8187
DR. JUSTIN LEE WOLFE DNP, APRN, FNP-BC
Nurse Practitioner (Family)
850 MARGARET PL
SHREVEPORT, LA 71101
Caddo Parish (318) 383-0163

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 Nova Vital Iop LLC's NPI number?

The NPI number for Nova Vital Iop LLC is 1477242196. It was assigned to this organization in the NPPES registry on May 8, 2023.

Where is Nova Vital Iop LLC located?

Nova Vital Iop LLC is located at 850 Margaret Pl, Shreveport, LA 71101. The listed phone number is (318) 268-6101.

What is Nova Vital Iop LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rehabilitation, Substance Use Disorder, with taxonomy code 261QR0405X.

Does Nova Vital Iop LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 19D2287261) is associated with this NPI, valid through August 10, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Nova Vital Iop LLC accept?

Health plans from Blue Cross and Blue Shield of Louisiana and HMO Louisiana list Nova Vital Iop LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Nova Vital Iop LLC was last updated on April 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.