| Shreveport Internal Medicine And Pediatrics Llc | |
|
10401 E Kings Hwy Shreveport LA 71115-3227 | |
| (318) 558-0880 | |
| (318) 562-6354 |
| Full Name | Shreveport Internal Medicine And Pediatrics Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 10401 E Kings Hwy, Shreveport, Louisiana |
| Authorized Official Name and Position | Allan S Matriano Lim (OWNER) |
| Authorized Official Contact | 3185880880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shreveport Internal Medicine And Pediatrics Llc 10401 E Kings Hwy Shreveport LA 71115-3227 Ph: (318) 588-0880 | Shreveport Internal Medicine And Pediatrics Llc 10401 E Kings Hwy Shreveport LA 71115-3227 Ph: (318) 558-0880 |
| NPI Number | 1710041900 |
|---|---|
| Provider Enumeration Date | 12/21/2006 |
| Last Update Date | 09/04/2024 |
| Medicare PECOS PAC ID | 9739283334 |
|---|---|
| Medicare Enrollment ID | O20070409000102 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710041900 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Kenneth C Fitzgerald |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811985245 PECOS PAC ID: 8022110915 Enrollment ID: I20070223000204 |
| Provider Name | Allan S Matriano-lim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649268590 PECOS PAC ID: 1456455062 Enrollment ID: I20070409000158 |
| Provider Name | Ashok R Kompelli |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932197886 PECOS PAC ID: 3173627783 Enrollment ID: I20070419000729 |
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