Healthcare Provider Details

I. General information

NPI: 1053502294
Provider Name (Legal Business Name): SIMBA VENTURES HOSPITAL LA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 LOUISIANA AVE
SHREVEPORT LA
71101-3908
US

IV. Provider business mailing address

1130 LOUISIANA AVE
SHREVEPORT LA
71101-3908
US

V. Phone/Fax

Practice location:
  • Phone: 318-227-1211
  • Fax: 318-678-4112
Mailing address:
  • Phone: 318-227-1211
  • Fax: 318-678-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK R. PFEIL
Title or Position: CHEIF FINANCIAL OFFICER
Credential:
Phone: 972-265-3115