1912909912 NPI number — BRFHH SHREVEPORT LLC

Table of content: (NPI 1912909912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912909912 NPI number — BRFHH SHREVEPORT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRFHH SHREVEPORT LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UNIVERSITY HEALTH SHREVEPORT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912909912
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1541 KINGS HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71103-4228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-626-0000
Provider Business Mailing Address Fax Number:
318-675-7531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1541 KINGS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71103-4228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-626-0000
Provider Business Practice Location Address Fax Number:
318-675-7531
Provider Enumeration Date:
08/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
VERNON
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
318-626-0000

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  142 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 124387 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1444405 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1705675 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 793527700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 720702002-001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: H0S0098N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00537776X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108357105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: HS8470P , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0020300 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1737712 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 026874 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0508374 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01370170 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100038750 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95012621 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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