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Organization

REGIONAL UROLOGY ASC LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. THOMAS E PALMER MD (OWNER/PHYSICIAN)
(318) 683-0411
Entity
Organization

Contact information

Practice address
255 BERT KOUNS INDUSTRIAL LOOP, SHREVEPORT, LA 71106-8150
(318) 683-0411
(318) 603-5461
Mailing address
255 BERT KOUNS INDUSTRIAL LOOP, SHREVEPORT, LA 71106-8150
(318) 683-0411
(318) 603-5461

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1445436
LA
01
CK2147
RAILROAD MEDICARE
LA
Enumeration date
09/16/2006
Last updated
01/07/2022
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