MEDICARE: SOUTHERN HILLS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	2203782204	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30386	OTHER		BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215923727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN HILLS LLC

Provider Business Mailing Address
First Line	:	9105 BAIRD RD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-3300
Country	:	US
Telephone Number	:	318-688-6691
Fax Number	:	318-688-2608

Provider Business Practice Location Address
First Line	:	9105 BAIRD RD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-3300
Country	:	US
Telephone Number	:	318-688-6691
Fax Number	:	318-688-2608

Authorized Official
Title or Position	:	AUTHORIZED REPRESENTATIVE
Name	:	MRS. TONI PARKINSON
Credential	:
Telephone Number	:	601-709-1408

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	06/22/2015

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Directions to “SOUTHERN HILLS LLC ” Practice Location

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