Organization
SURGICAL SUITES AT THE WALL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIMEON H. WALL JR. M.D. (MEDICAL DIRECTOR)
(318) 795-0801
Entity
Organization
Contact information
Practice address
8600 FERN AVENUE, STE. 200, SHREVEPORT, LA 71105
(318) 795-0801
(318) 795-9492
Mailing address
8600 FERN AVENUE, SHREVEPORT, LA 71105
(318) 795-0801
(318) 795-9492
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
09/10/2008
Last updated
04/21/2009
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