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General NPI Number Information
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NPI Number | 1043894231
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Entity Type | Organization
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Legal Business Name | ICP LOUISIANA ACO BILLING LLC
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Dates
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Enumeration Date | 05/12/2021
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 333 TEXAS ST STE 1300
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City | SHREVEPORT
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State | LA
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Zip | 71101-3783
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Country | US
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Telephone | 800-807-6555
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Fax | 855-316-2999
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Provider Business Mailing Address
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Address Line | 805 N WHITTINGTON PKWY STE 200
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City | LOUISVILLE
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State | KY
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Zip | 40222-7102
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Country | US
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Telephone | 800-807-6555
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Fax | 855-316-2999
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MARGARET S PEMBERTON
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Credential |
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Telephone | 502-394-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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