Organization
INTEGRA HEALTH SERVICES PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GAVIN F CHICO MD (MD/OWNER)
(318) 780-6230
Entity
Organization
Contact information
Practice address
1110 RINGGOLD AVE STE B, COUSHATTA, LA 71019-9004
(318) 798-4606
(318) 798-4601
Mailing address
PO BOX 53032, SHREVEPORT, LA 71135-3032
(318) 798-4606
(318) 798-4601
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD.11956R
LA
282E00000X
Long Term Care Hospital
MD.11956R
LA
283X00000X
Rehabilitation Hospital
MD.11956R
LA
Other
Enumeration date
07/25/2017
Last updated
03/17/2018
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