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General NPI Number Information
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NPI Number | 1962500850
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Entity Type | Organization
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Legal Business Name | MINIMALLY INVASIVE SURGERY CENTER OF LOUISIANA
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1534 ELIZABETH AVE STE 400
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City | SHREVEPORT
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State | LA
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Zip | 71101-4531
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Country | US
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Telephone | 318-227-2121
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1445
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City | SHREVEPORT
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State | LA
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Zip | 71164-1445
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Country | US
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Telephone | 318-227-2121
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES ROBERT BARNES
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Credential | M.D.
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Telephone | 318-227-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 14607R
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License Number State | LA
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