Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Rural Health |
261QR1300X | B4[14] | Rural Health Clinic | |
Family Medicine |
207Q00000X | 08 | Physician/Family Practice | |
Primary Care |
261QP2300X |
| NPI # | 1649993585 |
| LBN Legal business name | SOUTH BOSSIER MEDICAL |
| Authorized official | DAVID JONES - (CEO) |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | 09/26/2022 |
| Last updated | 12/09/2024 - More than a year ago |
| Identifiers | n/a |
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SOUTH BOSSIER MEDICAL
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| DEPARTMENT OF HEALTH & HOSPITAL 1310 NORTH HEARNE AVENUE SHREVEPORT, LA |