Organization
ARK-LA-TEX MEDICAL SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN P RESTOVICH (PRESIDENT)
(318) 218-5531
Entity
Organization
Contact information
Practice address
3825 GILBERT DR, SUITE 142, SHREVEPORT, LA 71104-5000
(318) 861-5907
(318) 861-5908
Mailing address
3825 GILBERT DR, SUITE 142, SHREVEPORT, LA 71104-5000
(318) 861-5907
(318) 861-5908
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023244
ACM
—
05
—
1544141
—
LA
01
—
F0589
BC/BS OF LA
—
Enumeration date
03/21/2006
Last updated
08/22/2020
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