Organization
SPECIALISTS HOSPITAL SHREVEPORT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KANDI G. MOORE (CEO)
(318) 632-6083
Entity
Organization
Contact information
Practice address
1500 LINE AVENUE, SUITE 206, SHREVEPORT, LA 71101-4639
(318) 213-3800
(318) 213-3801
Mailing address
1500 LINE AVENUE, SUITE 206, SHREVEPORT, LA 71101-4639
(318) 213-3800
(318) 213-3801
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
626
LA
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1702439
—
LA
Enumeration date
07/31/2009
Last updated
05/06/2011
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