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General NPI Number Information
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NPI Number | 1225068950
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Entity Type | Organization
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Legal Business Name | ST. LUKES REHABILITAION HOSPITAL
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2140 MIDWAY ST
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City | SHREVEPORT
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State | LA
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Zip | 71108-2206
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Country | US
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Telephone | 318-631-2345
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Fax |
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Provider Business Mailing Address
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Address Line | 2140 MIDWAY ST
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City | SHREVEPORT
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State | LA
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Zip | 71108-2206
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Country | US
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Telephone | 318-631-2345
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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. GARY L CAIN
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Credential |
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Telephone | 210-493-5565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | 547
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License Number State | LA
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