Organization
LSU HEALTH SCIENCES CENTER SHREVEPORT FACULTY GROUP PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MITZI GREEN (DIRECTOR)
(318) 626-0000
Entity
Organization
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 626-0284
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
207L00000X
Anesthesiology Physician
—
—
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
—
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
Other
Enumeration date
01/19/2016
Last updated
06/28/2023
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