MEDICARE: NORTH LOUISIANA SURGERY CENTER 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	174400000X	Specialist	MD.11148R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548464662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH LOUISIANA SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	1512 DOCTORS DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3322
Country	:	US
Telephone Number	:	318-746-7272
Fax Number	:

Provider Business Practice Location Address
First Line	:	1512 DOCTORS DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3322
Country	:	US
Telephone Number	:	318-746-7272
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. LARRY S SASAKI
Credential	:	M.D.
Telephone Number	:	318-746-7272

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	08/25/2014

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