Organization
COUSHATTA ER PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WYCHE TAYLOR COLEMAN JR. MD (MD/OWNER)
(318) 932-9980
Entity
Organization
Contact information
Practice address
1635 MARVEL ST, COUSHATTA, LA 71019-9022
(318) 932-9980
(318) 932-9906
Mailing address
PO BOX 52311, SHREVEPORT, LA 71135-2311
(318) 798-4539
(318) 798-4601
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2349309
—
LA
01
—
DU5881
RR MEDICARE
LA
Enumeration date
07/30/2013
Last updated
03/04/2016
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