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General NPI Number Information
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NPI Number | 1538350046
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Entity Type | Organization
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Legal Business Name | THOMAS E. KINSTREY A MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 09/01/2011
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Provider Practice Location Address
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Address Line | 2120 BERT KOUNS INDUSTRIAL LOOP SUITE M
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City | SHREVEPORT
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State | LA
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Zip | 71118-3351
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Country | US
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Telephone | 318-688-0319
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Fax | 318-686-3912
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Provider Business Mailing Address
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Address Line | 2120 BERT KOUNS INDUSTRIAL LOOP SUITE M
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City | SHREVEPORT
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State | LA
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Zip | 71118-3351
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Country | US
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Telephone | 318-688-0319
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Fax | 318-686-3912
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. THOMAS E KINSTREY
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Credential | M.D.
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Telephone | 318-688-0319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 05118R
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License Number State | LA
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