MEDICARE: JONAH HEALTHCARE, A PROFESSIONAL MEDICAL CORPORATION

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1952761686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONAH HEALTHCARE, A PROFESSIONAL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	2328 LINE AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-2131
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2328 LINE AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-2131
Country	:	US
Telephone Number	:	318-946-8793
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HOWARD LIPPTON
Credential	:
Telephone Number	:	318-946-8793

Provider Enumeration Date	:	02/23/2016
Last Update Date	:	02/23/2016

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