Organization
REGIONAL UROLOGY ASC LLC
Active
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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