Healthcare Provider Details

I. General information

NPI: 1629577895
Provider Name (Legal Business Name): BOSSIER FAMILY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2539 VIKING DR STE 100
BOSSIER CITY LA
71111-1611
US

IV. Provider business mailing address

2539 VIKING DR STE 101
BOSSIER CITY LA
71111-2165
US

V. Phone/Fax

Practice location:
  • Phone: 318-747-8105
  • Fax: 318-747-8150
Mailing address:
  • Phone: 318-747-8105
  • Fax: 318-747-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANDY L SPEARS
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 318-925-3338