Organization
SHRINERS HOSPITALS FOR CHILDREN
Active
Other names
Shriners Hospitals for Children Shreveport
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARRY KIM GREEN FACHE (ADMINISTRATOR)
(318) 222-5704
Entity
Organization
Contact information
Practice address
3100 SAMFORD AVE, SHREVEPORT, LA 71103-4239
(318) 222-5704
(318) 424-7610
Mailing address
SHRINERS HOSPITALS FOR CHILDREN, P.O. BOX 8500, LOCKBOX #7642, PHILADELPHIA, PA 19178-7642
(813) 281-8657
(813) 281-8113
Taxonomy
Speciality
Code
Description
License number
State
282NC2000X
Children's Hospital
Primary
179
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08155267
—
MS
05
—
149229
—
AL
01
—
179
HOSPITAL LICENSE NUMBER
LA
05
—
191748105
—
AR
05
—
200341270A
—
OK
01
—
258361
MEDICARE PART B (PTAN)
LA
05
—
2700031
—
LA
05
—
3168429
—
TX
Enumeration date
02/19/2007
Last updated
03/07/2014
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