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General NPI Number Information
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NPI Number | 1730156845
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Entity Type | Organization
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Legal Business Name | PULMONARY & CRITICAL CARE SPECIALISTS, L.L.C.
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 7829 YOUREE DR
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City | SHREVEPORT
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State | LA
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Zip | 71105-5505
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Country | US
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Telephone | 318-797-8777
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Fax |
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Provider Business Mailing Address
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Address Line | 7829 YOUREE DR
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City | SHREVEPORT
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State | LA
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Zip | 71105-5505
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Country | US
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Telephone | 318-797-8777
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GLADYS T BUSH
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Credential | CCMA
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Telephone | 318-797-8777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 00181035
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License Number State | LA
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