Healthcare Provider Details

I. General information

NPI: 1649563701
Provider Name (Legal Business Name): MISS-LOU INFUSION THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1643 CARTER STREET SUITE 1
VIDALIA LA
71373
US

IV. Provider business mailing address

PO BOX 14149
BATON ROUGE LA
70898-4149
US

V. Phone/Fax

Practice location:
  • Phone: 318-336-4444
  • Fax: 318-336-4411
Mailing address:
  • Phone: 318-336-4444
  • Fax: 318-336-4411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CRAIG GUILLORY
Title or Position: PRESIDENT
Credential:
Phone: 318-336-4444