Healthcare Provider Details

I. General information

NPI: 1730156845
Provider Name (Legal Business Name): PULMONARY & CRITICAL CARE SPECIALISTS, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7829 YOUREE DR
SHREVEPORT LA
71105-5505
US

IV. Provider business mailing address

7829 YOUREE DR
SHREVEPORT LA
71105-5505
US

V. Phone/Fax

Practice location:
  • Phone: 318-797-8777
  • Fax:
Mailing address:
  • Phone: 318-797-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number00181035
License Number StateLA

VIII. Authorized Official

Name: GLADYS T BUSH
Title or Position: ADMINISTRATOR
Credential: CCMA
Phone: 318-797-8777