1023075017 NPI number — DEPARTMENT OF HEALTH & HOSPITAL

Table of content: (NPI 1023075017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023075017 NPI number — DEPARTMENT OF HEALTH & HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPARTMENT OF HEALTH & HOSPITAL
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:
Provider Other Organization Name Type Code:
6
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:
1023075017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 7904
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:
71107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-676-5111
Provider Business Mailing Address Fax Number:
318-676-5021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 NORTH HEARNE AVENUE
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:
71107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-632-2040
Provider Business Practice Location Address Fax Number:
318-632-2073
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
ALLIE
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
ADMINISTRATIVE PROGRAM MANAGER
Authorized Official Telephone Number:
318-676-5111

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  115 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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