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General NPI Number Information
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NPI Number | 1649993585
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Entity Type | Organization
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Legal Business Name | SOUTH BOSSIER MEDICAL
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 5668 BARKSDALE BLVD
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City | BOSSIER CITY
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State | LA
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Zip | 71112
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Country | US
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Telephone | 318-735-1800
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Fax | 318-725-4960
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Provider Business Mailing Address
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Address Line | 5260 BARKSDALE BLVD
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City | BOSSIER CITY
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State | LA
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Zip | 71112
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAVID JONES
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Credential |
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Telephone | 318-375-4001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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