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Organization
SURGICAL SUITES AT THE WALL CENTER, LLC
Active
Organization
SURGICAL SUITES AT THE WALL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIMEON H. WALL JR. M.D. (MEDICAL DIRECTOR)
(318) 795-0801
Entity
Organization
Contact information
Practice address
8600 FERN AVENUE, STE. 200, SHREVEPORT, LA 71105
(318) 795-0801
(318) 795-9492
Mailing address
8600 FERN AVENUE, SHREVEPORT, LA 71105
(318) 795-0801
(318) 795-9492
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
09/10/2008
Last updated
04/21/2009
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