Organization
SHREVEPORT SURGERY CENTER PTRSHP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MARY BRIDGES RN (ADMINISTRATOR)
(318) 227-1163
Entity
Organization
Contact information
Practice address
745 OLIVE ST, SUITE 100, SHREVEPORT, LA 71104-2246
(318) 227-1163
Mailing address
PO BOX 4825, SHREVEPORT, LA 71134-0825
(318) 227-1163
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
14
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1334073
—
LA
01
—
21026
BLUE CROSS BLUE SHIELD
LA
Enumeration date
02/06/2007
Last updated
09/12/2013
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