Healthcare Provider Details

I. General information

NPI: 1265979561
Provider Name (Legal Business Name): TOTAL SPINAL IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 E 70TH ST UNIT 272
SHREVEPORT LA
71105-5115
US

IV. Provider business mailing address

8660 FERN AVE SUITE 120
SHREVEPORT LA
71105-5649
US

V. Phone/Fax

Practice location:
  • Phone: 832-667-8132
  • Fax: 281-664-5899
Mailing address:
  • Phone: 318-210-3011
  • Fax: 281-664-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SIAN R NAVA
Title or Position: OFFICE MANAGER
Credential:
Phone: 832-667-8132