Healthcare Provider Details

I. General information

NPI: 1851562813
Provider Name (Legal Business Name): LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CLAIBORNE AVE SCHOOL OF ALLIED HEALTH PROFESSIONS
SHREVEPORT LA
71103-4204
US

IV. Provider business mailing address

PO BOX 33932
SHREVEPORT LA
71130-3932
US

V. Phone/Fax

Practice location:
  • Phone: 318-813-2963
  • Fax: 318-813-2989
Mailing address:
  • Phone: 318-813-2962
  • Fax: 318-813-2975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: REVA MATTHIEW ROBINSON
Title or Position: DIRECTOR OF CLIN MGMT SYSTEM
Credential: MBA
Phone: 318-813-2962