Healthcare Provider Details

I. General information

NPI: 1982164968
Provider Name (Legal Business Name): ALLEGIANCE HEALTH MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 TEXAS ST STE 200
SHREVEPORT LA
71101-3526
US

IV. Provider business mailing address

504 TEXAS ST STE 200
SHREVEPORT LA
71101-3526
US

V. Phone/Fax

Practice location:
  • Phone: 318-629-3272
  • Fax: 318-226-8205
Mailing address:
  • Phone: 318-629-3272
  • Fax: 318-226-8205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number StateNULL

VIII. Authorized Official

Name: TRENAE AUSTIN
Title or Position: REVENUE ANALYST
Credential:
Phone: 318-629-3272