Organization
WHITE CLOVER, LLC
Active
Other names
White Clover Wellness & Research Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMARA M SMITH (CFO)
(318) 455-8856
Entity
Organization
Contact information
Practice address
8835 LINE AVE STE 400, SHREVEPORT, LA 71106-6730
(318) 861-4226
Mailing address
8835 LINE AVE STE 400, SHREVEPORT, LA 71106-6730
(318) 861-4226
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
022377
LA
Other
Enumeration date
12/30/2015
Last updated
12/30/2015
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