Organization
SHREVEPORT ENDOSCOPY CENTER, A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SATHYA JAGANMOHAN M.D. (PRESIDENT)
(318) 631-0072
Entity
Organization
Contact information
Practice address
3217 MABEL ST, SHREVEPORT, LA 71103-4022
(318) 631-0072
(318) 213-4979
Mailing address
3217 MABEL ST, SHREVEPORT, LA 71103-4022
(318) 631-0072
(318) 213-4979
Taxonomy
Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
50
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1910678
—
LA
01
—
50
STATE LICENSE
LA
Enumeration date
02/06/2006
Last updated
08/12/2022
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