| Louisiana State University Health Sciences Center Viral Disease Clini | |
|
6670 Saint Vincent Ave Shreveport LA 71106-2638 | |
| (318) 862-9986 | |
| Not Available |
| Full Name | Louisiana State University Health Sciences Center Viral Disease Clini |
|---|---|
| Speciality | Clinic/center |
| Location | 6670 Saint Vincent Ave, Shreveport, Louisiana |
| Authorized Official Name and Position | Robert Penn (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3187985930 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Louisiana State University Health Sciences Center Viral Disease Clini 1821 Bayou Dr Shreveport LA 71105-3403 Ph: (318) 865-2578 | Louisiana State University Health Sciences Center Viral Disease Clini 6670 Saint Vincent Ave Shreveport LA 71106-2638 Ph: (318) 862-9986 |
| NPI Number | 1285635540 |
|---|---|
| Provider Enumeration Date | 08/09/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285635540 | NPI | - | NPPES |
| 1697770 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Louisiana) | Primary |
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