Organization
SPORTMEDICA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM OVERDYKE MD (MEDICAL PHYSICIAN/ OWNER)
(318) 458-8490
Entity
Organization
Contact information
Practice address
2934 CHARDONNAY CIR, SHREVEPORT, LA 71106-8418
(318) 458-8490
Mailing address
2934 CHARDONNAY CIR, SHREVEPORT, LA 71106-8418
(318) 458-8490
Taxonomy
Speciality
Code
Description
License number
State
283X00000X
Rehabilitation Hospital
Primary
MD.014596
LA
Other
Enumeration date
10/08/2015
Last updated
10/08/2015
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