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General NPI Number Information
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NPI Number | 1194784173
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Entity Type | Organization
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Legal Business Name | MEDICAL INFUSION THERAPY OF LA
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 08/30/2007
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Provider Practice Location Address
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Address Line | 1525 DOCTORS DR
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City | BOSSIER CITY
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State | LA
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Zip | 71111-3321
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Country | US
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Telephone | 318-741-1009
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Fax | 318-741-1842
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Provider Business Mailing Address
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Address Line | 1525 DOCTORS DR
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City | BOSSIER CITY
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State | LA
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Zip | 71111-3321
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Country | US
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Telephone | 318-741-1009
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Fax | 318-741-1842
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Authorized Official
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Title or Position | OWNER - ADMINISTRATOR
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Name | MRS. JEAN HOOGENDYK
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Credential | RN
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Telephone | 318-741-1009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number | 4428 IR
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License Number State | LA
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