Organization
PHOENIX HEALTH SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SURESH K DONEPUDI M.D. (OWNER)
(318) 688-5416
Entity
Organization
Contact information
Practice address
2021 LINE AVE, SHREVEPORT, LA 71104-2124
(318) 221-0661
(318) 221-0662
Mailing address
8921 MANSFIELD RD, SHREVEPORT, LA 71118-2144
(318) 688-5416
(318) 688-5823
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
07/13/2006
Last updated
08/08/2008
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