Healthcare Provider Details

I. General information

NPI: 1285253252
Provider Name (Legal Business Name): OCHSNER LSU HEALTH SHREVEPORT - ST. MARY MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 MARGARET PL
SHREVEPORT LA
71101-4347
US

IV. Provider business mailing address

1512 W KIRBY PL
SHREVEPORT LA
71103-3822
US

V. Phone/Fax

Practice location:
  • Phone: 318-626-4300
  • Fax: 318-399-7683
Mailing address:
  • Phone: 318-626-0287
  • Fax: 318-629-4833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282NW0100X
TaxonomyWomen's Hospital
License Number
License Number State

VIII. Authorized Official

Name: MITZI GREEN
Title or Position: DIRECTOR
Credential:
Phone: 318-626-0050