Organization
MEDICAL INFUSION THERAPY OF LA
Active
Organization
MEDICAL INFUSION THERAPY OF LA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JEAN HOOGENDYK RN (OWNER - ADMINISTRATOR)
(318) 741-1009
Entity
Organization
Contact information
Practice address
1525 DOCTORS DR, BOSSIER CITY, LA 71111-3321
(318) 741-1009
(318) 741-1842
Mailing address
1525 DOCTORS DR, BOSSIER CITY, LA 71111-3321
(318) 741-1009
(318) 741-1842
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary
4428 IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1264733
—
LA
Enumeration date
03/20/2006
Last updated
08/30/2007
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