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General NPI Number Information
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NPI Number | 1295974574
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Entity Type | Organization
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Legal Business Name | OVERTON BROOKS VAMC
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 510 E STONER AVE
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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 | 318-990-5387
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Fax |
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Provider Business Mailing Address
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Address Line | 535 ANTIETAM DR
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City | BOSSIER CITY
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State | LA
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Zip | 71112-4789
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Country | US
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Telephone | 318-990-5387
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | CRUSHUNDA MONIQUE JOHNSON
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Credential | M.S.W.
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Telephone | 318-990-5387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 8840
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License Number State | LA
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