Healthcare Provider Details

I. General information

NPI: 1487949814
Provider Name (Legal Business Name): SENIOR HEALTH NOW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 LINE AVE
SHREVEPORT LA
71104-2131
US

IV. Provider business mailing address

2326 LINE AVE
SHREVEPORT LA
71104-2131
US

V. Phone/Fax

Practice location:
  • Phone: 318-617-6029
  • Fax: 318-670-1253
Mailing address:
  • Phone: 318-617-6029
  • Fax: 318-670-1253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number017954
License Number StateLA

VIII. Authorized Official

Name: DR. HOWARD LIPPTON
Title or Position: MANAGER
Credential: MD
Phone: 318-617-6029