Healthcare Provider Details

I. General information

NPI: 1215997838
Provider Name (Legal Business Name): ACCUMED OF NORTH LOUISIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 CAMBRIDGE CIR
SHREVEPORT LA
71107-3535
US

IV. Provider business mailing address

4651 CAMBRIDGE CIR
SHREVEPORT LA
71107-3535
US

V. Phone/Fax

Practice location:
  • Phone: 318-629-1588
  • Fax: 318-629-1589
Mailing address:
  • Phone: 318-629-1588
  • Fax: 318-629-1589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: WALTER RANDALL PATTON
Title or Position: GENERAL MANAGER
Credential:
Phone: 318-629-1588