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Organization

CITY OF SHREVEPORT

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. SANDRA L NIEMI (BILLING MANAGER)
(318) 747-9977
Entity
Organization

Contact information

Practice address
505 TRAVIS ST, SHREVEPORT, LA 71101-3042
(318) 747-9977
(318) 747-9994
Mailing address
PO BOX 34500, SHREVEPORT, LA 71130-4500
(318) 747-9977
(318) 747-9994

Taxonomy

Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
16332
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1392278
LA
01
27751
BLUE CROSS BLUE SHIELD
LA
01
590005183
RAILROAD MEDICARE
LA
Enumeration date
03/21/2007
Last updated
07/09/2010
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