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General NPI Number Information
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NPI Number | 1154561223
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Entity Type | Organization
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Legal Business Name | BELLAH MEDICAL, LLC
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Dates
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Enumeration Date | 03/02/2009
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Last Update Date | 03/02/2009
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Provider Practice Location Address
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Address Line | 1801 FAIRFIELD AVE SUITE 409
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City | SHREVEPORT
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State | LA
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Zip | 71101-4443
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Country | US
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Telephone | 318-841-2801
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Fax | 318-841-2800
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Provider Business Mailing Address
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Address Line | 1801 FAIRFIELD AVE. SUITE 409
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City | SHREVEPORT
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State | LA
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Zip | 71104
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Country | US
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Telephone | 318-841-2801
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Fax | 318-841-2800
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Authorized Official
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Title or Position | OWNER
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Name | DR. LLOYD D BELLAH
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Credential | M.D.
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Telephone | 318-841-2801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | K0260
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 12606R
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License Number State | LA
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