Healthcare Provider Details

I. General information

NPI: 1689112526
Provider Name (Legal Business Name): GUIDCO MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 HOSPITAL DR SUITE 130
BOSSIER CITY LA
71111-2385
US

IV. Provider business mailing address

2830 COVINGTON CIR
SHREVEPORT LA
71106-8294
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-7990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number300758
License Number StateLA

VIII. Authorized Official

Name: DR. PAUL GUIDRY
Title or Position: OWNER
Credential: M.D.
Phone: 225-955-5158