Healthcare Provider Details

I. General information

NPI: 1235625252
Provider Name (Legal Business Name): DISCRETE ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 PINE HILL RD
SHREVEPORT LA
71107
US

IV. Provider business mailing address

5100 PINE HILL RD
SHREVEPORT LA
71107-2604
US

V. Phone/Fax

Practice location:
  • Phone: 318-617-5100
  • Fax:
Mailing address:
  • Phone: 318-617-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number10010142961
License Number StateLA

VIII. Authorized Official

Name: BARBARA MARIE ALLEN
Title or Position: CEO
Credential: BOARD CERTIFIED COUN
Phone: 318-617-5100