1396861415 NPI number — CITY OF SHREVEPORT

Table of content: (NPI 1396861415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396861415 NPI number — CITY OF SHREVEPORT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF SHREVEPORT
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:
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:
1396861415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34500
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:
71130-4500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-747-9977
Provider Business Mailing Address Fax Number:
318-747-9994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 TRAVIS ST
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:
71101-3042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-747-9977
Provider Business Practice Location Address Fax Number:
318-747-9994
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NIEMI
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
318-747-9977

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  16332 , 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)

  • Identifier: 1392278 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590005183 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 27751 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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