Healthcare Provider Details

I. General information

NPI: 1013421056
Provider Name (Legal Business Name): JAMES FORD MHS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 HEARNE AVE
SHREVEPORT LA
71103
US

IV. Provider business mailing address

404 HEARNE AVE
SHREVEPORT LA
71103-2022
US

V. Phone/Fax

Practice location:
  • Phone: 318-716-1369
  • Fax: 318-675-0120
Mailing address:
  • Phone: 318-716-1369
  • Fax: 318-675-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: