Healthcare Provider Details

I. General information

NPI: 1275770620
Provider Name (Legal Business Name): SHAMA PULMONARY REHAB. CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E JEFFERSON ST
OAK GROVE LA
71263-2535
US

IV. Provider business mailing address

102 N HYATT ST
MONTICELLO AR
71655-4022
US

V. Phone/Fax

Practice location:
  • Phone: 318-428-8233
  • Fax: 318-428-3424
Mailing address:
  • Phone: 870-224-0380
  • Fax: 870-224-0382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberLT3348
License Number StateLA

VIII. Authorized Official

Name: MRS. TERESA C FOURROUX
Title or Position: PRESIDENT
Credential:
Phone: 870-224-0380