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General NPI Number Information
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NPI Number | 1851737506
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Entity Type | Organization
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Legal Business Name | ARK-LA-TEX SPINE APMC
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Dates
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Enumeration Date | 05/21/2013
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Last Update Date | 05/12/2016
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Provider Practice Location Address
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Address Line | 8660 FERN AVE SUITE 120
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City | SHREVEPORT
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State | LA
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Zip | 71105-5649
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Country | US
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Telephone | 903-487-2248
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Fax | 903-487-2306
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Provider Business Mailing Address
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Address Line | PO BOX 837
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City | HOWE
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State | TX
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Zip | 75459-0837
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Country | US
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Telephone | 903-487-2248
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Fax | 903-487-2306
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Authorized Official
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Title or Position | OWNER
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Name | JEFFEREY ADAIR
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Credential | MD
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Telephone | 903-487-2248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | MD020437
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License Number State | LA
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