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General NPI Number Information
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NPI Number | 1174863336
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Entity Type | Organization
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Legal Business Name | SLSC MEDICAL STAFF
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Dates
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Enumeration Date | 02/26/2013
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Last Update Date | 09/20/2019
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Provider Practice Location Address
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Address Line | 8711 LINE AVE
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City | SHREVEPORT
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State | LA
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Zip | 71106-6813
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Country | US
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Telephone | 318-841-4486
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Fax | 318-841-4489
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Provider Business Mailing Address
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Address Line | 8711 LINE AVE
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City | SHREVEPORT
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State | LA
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Zip | 71106-6813
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Country | US
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Telephone | 318-698-8711
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Fax | 318-841-4489
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH W SANDERS
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Credential | MD
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Telephone | 318-841-4486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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