Organization
JEFFERSON DAVIS PHYSICIAN SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISHA C FALK (VP OF CONTRACTING)
(337) 609-1221
Entity
Organization
Contact information
Practice address
1634 ELTON RD, JENNINGS, LA 70546-3614
(800) 893-9698
Mailing address
200 COPORATE BLVD., LAFAYETTE, LA 70508
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
LA
363A00000X
Physician Assistant
—
LA
363L00000X
Nurse Practitioner
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2406141
—
LA
Enumeration date
09/16/2015
Last updated
03/23/2022
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