Organization
SNELLS LIMBS & BRACES OF SHREVEPORT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLYDE N. MASSEY C.P.O. (VICE PRESIDENT)
(318) 424-4167
Entity
Organization
Contact information
Practice address
1833 LINE AVE, SHREVEPORT, LA 71101-4611
(318) 424-4167
Mailing address
1833 LINE AVE, SHREVEPORT, LA 71101-4611
(318) 424-4167
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1017710
—
LA
01
—
78361
BLUECROSS OF LA PROVIDER
LA
Enumeration date
01/16/2007
Last updated
11/15/2012
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