Organization
LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
Active
Organization
LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
Active
Other names
LSUHSC-S Department of Anesthesiology
Organization subpart
No
Provider details
NPI number
Authorized official
MELANIE H SOTAK MHSA (DIRECTOR OF MANAGED CARE)
(318) 675-5584
Entity
Organization
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-5584
Mailing address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-5584
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207P00000X
Emergency Medicine Physician
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
077717902
—
TX
05
—
1946087
—
LA
Enumeration date
10/17/2006
Last updated
12/01/2010
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