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General NPI Number Information
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NPI Number | 1265675029
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Entity Type | Organization
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Legal Business Name | MARTIN LUTHER KING HEALTH CENTER
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 04/09/2009
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Provider Practice Location Address
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Address Line | 1233 SPRAGUE ST.
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City | SHREVEPORT
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State | LA
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Zip | 71101
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Country | US
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Telephone | 318-227-2912
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Fax | 318-227-8105
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Provider Business Mailing Address
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Address Line | 1233 SPRAGUE ST.
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City | SHREVEPORT
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State | LA
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Zip | 71101
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Country | US
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Telephone | 318-227-2912
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Fax | 318-227-8105
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JANET M MENTESANE
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Credential |
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Telephone | 318-227-2912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 2441-CH
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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