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General NPI Number Information
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NPI Number | 1265523997
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Entity Type | Organization
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Legal Business Name | OVERTON BROOKS VA HOSPITAL
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 510 E STONER AVE # 126
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City | SHREVEPORT
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State | LA
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Zip | 71101-4243
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Country | US
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Telephone | 318-424-6090
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Fax |
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Provider Business Mailing Address
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Address Line | 510 E STONER AVE # 126
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City | SHREVEPORT
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State | LA
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Zip | 71101-4243
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Country | US
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Telephone | 318-424-6090
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Fax |
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Authorized Official
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Title or Position | AUDIOLOGY COORDINATOR
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Name | MR. ROBERT F. HALL
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Credential | M.S., CCC-A
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Telephone | 318-424-6090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 5691
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License Number State | LA
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