Healthcare Provider Details

I. General information

NPI: 1427480680
Provider Name (Legal Business Name): COUSHATTA ER PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2013
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 MARVEL ST
COUSHATTA LA
71019-9022
US

IV. Provider business mailing address

PO BOX 52311
SHREVEPORT LA
71135-2311
US

V. Phone/Fax

Practice location:
  • Phone: 318-932-9980
  • Fax: 318-932-9906
Mailing address:
  • Phone: 318-798-4539
  • Fax: 318-798-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WYCHE TAYLOR COLEMAN JR.
Title or Position: MD/OWNER
Credential: MD
Phone: 318-932-9980