# INTEGRA HEALTH SERVICES PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861915415
- **Authorized official:** DR. GAVIN F CHICO MD (MD/OWNER)
- **Authorized official phone:** (318) 780-6230

## Contact information

- **Practice address:** 1110 RINGGOLD AVE STE B, COUSHATTA, LA 71019-9004
- **Practice address phone:** (318) 798-4606
- **Practice address fax:** (318) 798-4601
- **Mailing address:** PO BOX 53032, SHREVEPORT, LA 71135-3032
- **Mailing address phone:** (318) 798-4606
- **Mailing address fax:** (318) 798-4601

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | MD.11956R | LA | Yes |
| 282E00000X | Long Term Care Hospital | MD.11956R | LA | — |
| 283X00000X | Rehabilitation Hospital | MD.11956R | LA | — |

## Other

- **Enumeration date:** 07/25/2017
- **Last updated:** 03/17/2018