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General NPI Number Information
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NPI Number | 1063701878
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Entity Type | Organization
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Legal Business Name | GPN MANY LLC
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 240 HIGHLAND DR
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City | MANY
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State | LA
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Zip | 71449-3718
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Country | US
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Telephone | 318-256-5691
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3923
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City | SHREVEPORT
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State | LA
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Zip | 71133-3923
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Country | US
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Telephone | 888-447-2450
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. SAM D HUCKABEE
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Credential |
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Telephone | 318-469-1132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State | LA
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