INTEGRATED DERMATOLOGY OF PONCHATOULA, LLC - NPI 1508234600

Q: What is Integrated Dermatology Of Ponchatoula, LLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

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About Integrated Dermatology Of Ponchatoula, Llc NPPES

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

INTEGRATED DERMATOLOGY OF PONCHATOULA, LLC (NPI 1508234600) is a healthcare organization registered as a dermatology in Ponchatoula, Louisiana and active in the NPI registry since September 2015. The organization holds 2 active CLIA laboratory certificates and lists Jeffrey Queen, Manager, as its authorized official.

NPPES Registry Identity

NPI1508234600

Entity TypeOrganization

Primary Taxonomy207N00000X

Legal Business NameINTEGRATED DERMATOLOGY OF PONCHATOULA, LLC

Location Address180 N 5TH STPonchatoula, LA 70454-2532

Mailing Address4700 Exchange Ct Ste 110Boca Raton, FL 33431-4450 · (561) 314-2000

Phone(985) 370-7546

Organization SubpartNo

Authorized OfficialJeffrey QueenManager · (561) 314-2000

Enumeration DateSeptember 4, 2015

Last NPPES UpdateMay 21, 2019

✔ NPI 1508234600 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians

Taxonomy Code207N00000X

Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

180 N 5TH ST, Ponchatoula, LA 70454

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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 2

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 Compliance 19D2120643

Integrated Dermatology Of Ponchatoula, LLC · Ponchatoula, LA

Active · expires Apr 12, 2027

CLIA Number19D2120643

Laboratory TypePhysician Office

Certificate Effective DateApril 13, 2025

Certificate Expiration DateApril 12, 2027

Laboratory DirectorNicholas Franks

Laboratory Phone(985) 370-7546

Laboratory LocationIntegrated Dermatology Of Ponchatoula, LLC180 N 5th Street, Ponchatoula, LA 70454

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 19D2121208

Integrated Dermatology · Amite, LA

Active · expires Oct 31, 2026

CLIA Number19D2121208

Laboratory TypePhysician Office

Certificate Effective DateNovember 1, 2024

Certificate Expiration DateOctober 31, 2026

Laboratory DirectorRobert W. Benson

Laboratory Phone(985) 370-7546

Laboratory LocationIntegrated Dermatology309 West Walnut Street, Ste A, Amite, LA 70422

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 7

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

KIMBERLY PATERNOSTRO BORDELON

Nurse Practitioner (Family)