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General NPI Number Information
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NPI Number | 1588467070
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Entity Type | Organization
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Legal Business Name | MEDIVUE LLC
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 2525 VIKING DR
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City | BOSSIER CITY
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State | LA
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Zip | 71111-2103
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Country | US
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Telephone | 318-841-2525
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Fax | 318-300-4403
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Provider Business Mailing Address
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Address Line | PO BOX 19196
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City | SHREVEPORT
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State | LA
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Zip | 71149-0196
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Country | US
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Telephone | 318-364-9144
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Fax | 469-854-0386
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Authorized Official
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Title or Position | CEO
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Name | TUSHAR PAWAR
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Credential |
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Telephone | 469-640-4264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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