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SHREVEPORT ENDOSCOPY CENTER, A MEDICAL CORPORATION

Endoscopy

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Contact Information

SHREVEPORT ENDOSCOPY CENTER, A MEDICAL CORPORATION
3217 MABEL ST
SHREVEPORT, LA  71103-4022
 Phone: 318-631-0072
 Fax: 318-213-4979
 Website:
 

Specialty

 Taxonomy Code Specialty Code Provider Type

Endoscopy

 261QE0800X
Indicates primary specialty

NPI Profile & details for SHREVEPORT ENDOSCOPY CENTER, A MEDICAL CORPORATION

NPI Number 1982676771
LBN Legal business name SHREVEPORT ENDOSCOPY CENTER, A MEDICAL CORPORATION
Authorized official SATHYA JAGANMOHAN - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 02/06/2006
Last updated 08/12/2022 - About 4 years ago
Identifiers
LA License # 50
LA Medicaid 1910678
LA Other 50 STATE LICENSE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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